Please note, some of the examples in the Appendices may be outdated and may have changed. Those changes may not be reflected in this document.

Example #1: Courtesy of Maryland Department of Health and Mental Hygiene

Agreement for Accessing Restricted Websites


Staff members that perform Internet Partner Services (IPS) are often required to access websites that are restricted and may contain adult oriented material during the course of their normal job duties. This agreement has been developed to establish clear expectations when restricted sites are to be accessed while performing IPS, and the consequences for acting outside of these expectations. All staff performing IPS must sign this agreement prior to being granted access to restricted websites


  1. I agree to access restricted websites for official business only.
  2. I understand all passwords are confidential.
  3. I understand I must not disclose passwords to anyone other than an authorized individual, nor may I make any password accessible to persons other than my immediate supervisor, or an equally authorized co-worker.
  4. I understand passwords are for official business only, and I will not use website passwords, profiles, pages, avatars, email accounts, or other technology for any personal endeavors.
  5. I understand I am not to use my personal home computer for any endeavors related to official department business.
  6. I understand that my use of department equipment such as a computer or a cell phone will be monitored.
  7. I understand I must document my internet activities, dates, times, and sites visited on the Internet-Based Partner Services Website Log Sheet.
  8. I understand I am to print out all correspondence and keep a copy in a place designated by my supervisor.
  9. I understand all correspondence must conform to existing policies and procedures regarding Internet-Based Partner Services.
  10. I understand I will be subject to disciplinary action should I engage in any activities on restricted websites outside the boundaries of my job requirements.

I have read, understand, and agree to comply with this agreement.

___________________________                              _________________

Employee Name                                           Date

Example #2: Courtesy of the State of Tennessee

Acceptable Use Policy

Network Access Rights and Obligations

User Agreement Acknowledgement

As a user of State of Tennessee data and resources, I agree to abide by the Acceptable Use Network Access Rights and Obligations Policy and the following promises and guidelines as they relate to the policy established:

  1. I will protect State confidential data, facilities, and systems against unauthorized disclosure and/or use.
  2. I will maintain all computer access codes in the strictest of confidence, immediately change them if I suspect their secrecy has been compromised, and report activity that is contrary to the provisions of this agreement to my supervisor or a State-authorized Security Administrator.
  3. I will be accountable for all transactions performed using my computer access codes.
  4. I will not disclose any confidential information other than to persons authorized to access such information as identified by my section supervisor.
  5. I agree to report to the Office for Information Resources (OIR) any suspicious network activity or security breach.

Privacy Expectations

The State of Tennessee actively monitors network services and resources, including, but not limited to, real-time monitoring. Users should have no expectation of privacy. These communications are considered to be State property and may be examined by management for any reason including, but not limited to, security and/or employee conduct.

I acknowledge that I must adhere to this policy as a condition for receiving access to State of Tennessee data and resources.

I understand the willful violation or disregard of any of these guidelines, statutes, or policies may result in my loss of access and disciplinary action, up to and including termination of my employment, termination of my business relationship with the State of Tennessee, and any other appropriate legal action, including possible prosecution under the provisions of the Computer Crimes Act as cited at TCA 39-14-601 et seq., and other applicable laws.

I have read and agree to comply with the policy set forth herein.

_________________________________                             ______________________________

Type or Print Name                                                                                 Last 4 digits of Social Security Number


______________________________________                ______________________________________

Signature                                                                                                    Date

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