Fill and Sign the Recorded Surveillance Form

Consent of Employee to be Monitored and Recorded for Security Purposes Pursuant to Closed-Circuit Video Surveillance Whereas, ________ , Inc., hereinafter referred to as Employer, owns and operates a ________________ (e.g., business, factory, plant) located at ____________________________ (street address, city, county, state, zip code ), hereinafter called Premises; and Whereas, ____________ (Name of Employee) hereinafter referred to as Employee, either desires to be employed by or is employed by Employer on Premises; and Whereas, Employee recognizes the need for closed-circuit video surveillance on and about Premises for security and productivity purposes; and Whereas, Employee recognizes and agrees that it is a condition of employment and/or continuing employment with Employer that Employee freely execute and agree to this closed- circuit video surveillance, included being personally recorded pursuant to said closed-circuit video surveillance; Now, therefore, for and in consideration of employment with Employer, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Employee agrees as follows: 1. Employee consents to being the subject of the said closed-circuit video surveillance program of Employer and to being recorded and taped as a result of said closed-circuit video surveillance on or about Premises . 2. Employee agrees that Employer may use any taping of said Employee’s image, voice or appearance at any time pursuant to said closed-circuit video surveillance at Employer’s discretion in the ordinary course of Employer’s operations. 3. Employee agrees to indemnify and save harmless Employer, its agents, successors and assigns, from any and all claims and liability for damages, losses or expenses of any sort arising from the making of such recordings of Employee and their lawful and appropriate use. Employee further acknowledges that Employer exclusively owns all rights to these recordings regardless of the form in which they are produced or used. Witness my signature this the _____ day of ___________, 20___. _______________________________ Signature of Employee _______________________________ Signature of Witness