Application for Volunteer Work Volunteer Services All new volunteers are required to complete an Application for Volunteer Work form. The information on this form will be treated in strict confidence under the Privacy Act of 2002 and National Privacy Principles. Your details will only be used in connection with prospective volunteer work with (NHW). There are a number of key questions on the form, which are explained as follows: Referees: Before a formal offer to work as a volunteer is made a referee check must be made by NHW. Referees are nominated by the applicant and must be current. Referees should be notified of the application. Physical/Medical: NHW is committed to providing a safe working environment for all volunteers to ensure that volunteers are not required to complete tasks that they are not able to perform safely. Checks: In accordance with National Legislation and NHW Policies, all volunteers are required to undergo a National Police Check, Working With Children and Commonwealth Statutory Declaration. 1) Personal details: Family Name: Given names: Email Address: Postal Address: Town: Postcode: Phone Work: ( ) Home: ( ) Mobile: Date of Birth: / / Name to appear on ID badge: 3) Type of volunteer work sought: NHW offers two types of volunteering opportunities, client contact and general assistance (non-client contact). Opportunities are always arising across the organisation and through the interview process we will determine with you where your interests lie. Please indication if you have a particular program area or interest: 4) Do you have any community service or work for the dole commitments to fulfil? YES or NO If YES, please provide details: 5) Why do you want to volunteer with NHW? 6) How did you hear about our volunteer service? 7) Are you a permanent resident of Australia? YES or NO If NO, please provide following details: Passport Number: Expiry Date: / / 8) All volunteers are required to undergo a National Police Check (renewed every 3 years), Working with Children Check (renewed every 5 years) and provide a Commonwealth Statutory Declaration stating that you have not been convicted of a criminal offence either within Australia or overseas. This documentation will be processed by the Volunteer Coordinator upon placement. a. Have you been convicted of a criminal offence? YES or NO If YES, please state below the details of each offence including dates: b. Have you lived overseas since the age of 16? YES or NO NHW0001372 03/15 Page 1 of 2
9) Do you hold a current drivers licence? YES or NO If YES, please provide following details: Licence Number: Expiry Date: / / 10) Do you hold current comprehensive car insurance? YES or NO If YES, please provide following details: Policy Number: Expiry Date: / / 11) NHW must ensure that you can perform the duties of a volunteer safely. Please give details below of anything that might affect your ability to perform volunteer work or might affect your safety or the safety of others. Include: Any relevant medical condition or incapacity; any relevant training needs; any specific facilities you may need. 12) Do you speak any languages other than English? YES NO If YES, language 13) Emergency/Next of Kin contact numbers: (please provide two people who can be contacted in case of an emergency) Name Relationship Home Phone Work Phone Mobile Phone 14) Previous paid employment or volunteer work: (this allows us to get an idea of life experience) Role Organisation Paid or Voluntary 15) Referees: (person must NOT be related to you) Name Position and Company Phone Relationship 16) How often are you available to volunteer: Twice weekly Weekly Fortnightly Monthly Quarterly Annually Other I [name] certify that to the best of my knowledge, the above particulars are correct. As a condition of working as a volunteer at, I agree to comply with the relevant Organisational By-laws, policies and regulations that apply from time to time. Signature of applicant: Date: / / Parental Consent (This section of the application form must be completed for all applicants 17 years of age and under) I Parent/Guardian name: I give permission for to work as a volunteer for. Parent/guardian signature: Date: / / Thank you for applying to volunteer with us, please return completed form to: Volunteer Services,, PO Box 386, Wangaratta Vic 3676 NHW0001372 03/15 Page 2 of 2
Volunteer Agreement Volunteer Services By my signature below I confirm that I have read and understand my Rights and Responsibilities as a volunteer at (NHW) and will, 1. Accept responsibility for my own transportation to and from NHW. 2. Notify the Volunteer Supervisor or NHW Volunteer Coordinator if I am unable to attend on my assigned day. 3. Be provided with a meal when assisting authorised staff during trips away from NHW if in excess of 5 hours. 4. When acting on behalf of NHW, wear my NHW Volunteer Name Badge at all times. I understand that this badge remains the property of NHW and will only be worn by me during periods of volunteer work and will be securely stored in the designated area when not in use. 5. Sign the Attendance Book at the commencement and completion of each period of volunteer work. 6. Advise and report any accident or incident that may occur with a client or myself, by immediately notifying the Volunteer Supervisor or person in charge. 7. Abide all NHW policies and procedures, By-Laws and agreements that apply from time to time and comply with all relevant legislation in relation to my work as a volunteer. 8. Notify the NHW Volunteer Coordinator in writing, giving 2 weeks notice, of my resignation. 9. Only undertake those tasks requested of me by my supervisor. 10. Understand that direct patient care is not part of my volunteer role. 11. Comply with a probationary period of four sessions and agree to work under direct supervision during this time. I acknowledge that during the probationary period either party may withdraw from this agreement, giving one session s notice. Within 2 weeks of the successful completion of this probationary period, continuation of my services as a volunteer, will be negotiated. 12. I understand the correct line of communication regarding any difficulties encountered as a volunteer should be address to my Volunteer Supervisor in the first instance or, if not available, the Volunteer Coordinator. Volunteer Statement By signing this, I agree that I have read, understood and will comply with this agreement. (print full name) Signed Date NHW0001371 03/15 Page 1 of 1
PRIVACY CONFIDENTIALITY & SECURITY AGREEMENT (For all persons, including staff, contractors, volunteers and students) As part of my position/employment at (NHW), I am required to understand and agree to the following: 1. I WILL ONLY access information I need to do my job. 2. I WILL NOT disclose, copy, release, sell, alter or destroy any confidential information unless it is part of my job. If it is part of my job to do any of these tasks, I will follow the correct procedure (such as putting confidential papers in appropriate shredding bins or using appropriate NHW procedures). 3. I WILL NOT misuse or be careless with confidential information. 4. I WILL NOT disclose my personal computer passwords and will only use shared passwords in authorised situations. 5. I ACCEPT responsibility for all activities I have undertaken using my password and those activities undertaken by persons to whom I have provided my password. 6. I KNOW that my access to confidential information may be audited. 7. I WILL NOT remove confidential information (eg medical records, photocopied patient forms or electronic data) from NHW unless it is an authorised work practice. I understand that this includes sending data via unsecured e-mail or to my home computer. 8. I WILL NOT disclose NHW building entry codes to unauthorised people. 9. I WILL report any activities to my manager that I suspect may compromise the confidentiality of information. I understand these reports, made in good faith, will be held in confidence to the extent permitted by law. 10. I WILL endeavour to wear my NHW identification badge at all times whilst on NHW premises. 11. I WILL protect the privacy of NHW patients and employees. 12. I AM RESPONSIBLE for my use or misuse of confidential information. 13. I UNDERSTAND my obligations under this agreement will continue after termination of my employment. I am aware that failure to comply with this agreement may result in termination of my position/employment at and/or civil or criminal legal penalties. Volunteer Statement By signing this, I agree that I have read, understood and will comply with this agreement. (print full name) Signed Date NHW0001373 03/15 Page 1 of 1
Rights & Responsibilities of a Volunteer The volunteer service at (NHW) endeavours to enhance and compliment staff with the aim of promoting the highest quality of patient care whilst striving to provide comprehensive health and well-being to our patients and the community we serve. Objectives To support and assist professional staff in providing and promoting the highest quality of patient care, both in acute and sub-acute health provision. To support the professional staff to ensure the client s stay at NHW is as comfortable as possible. To endeavour to be of assistance and support to the families and friends of clients, without encroaching on their privacy. To provide a channel through which members of the community can contribute resources, energy and ideas for the benefit of the hospital. Volunteer Coordinator The Volunteer Coordinator is responsible for the allocation of volunteers within the organisation. Your Rights as a Volunteer To receive a duty statement that clearly defines the duties of a volunteer. To receive training, initial and ongoing. To be able to ask for a new assignment when ready for a new challenge. To feel free to consult the Volunteer Coordinator regarding suggestions or complaints. To have a safe place of work. To have a place of work free from any form of harassment. To be kept informed of new developments at the hospital via newsletters and meetings. To know to whom they are accountable and to have clearly defined channels of communication. To be treated as a recognised member of NHW employee population. Including OH&S, Fire and Evacuation, EEO compliance. Your Responsibilities as a Volunteer Commitment A minimum commitment of regular weekly hours over a 12 month period. These hours are to be negotiated with the Volunteer Coordinator. To inform the Volunteer Coordinator if an assignment is unsatisfactory and negotiate change. To receive medical attention from the Accident and Emergency Department should a volunteer become ill whilst on duty. Accountability All volunteers will have direct line responsibility to the Volunteer Coordinator. Day to day supervision will be provided by the designated Department Volunteer Supervisor. Punctuality Report to assigned area, according to duty statement at agreed time of commencement. Absence from duty If unable to attend for rostered duty, notify the Department Volunteer Supervisor or Volunteer Coordinator. NHW0001374 03/15 Page 1 of 3
If injured/ill whilst volunteering, you are required to notify your immediate supervisor prior to leaving your workplace. If no notification is received for 3 weeks, the volunteer will automatically be taken off the roster. Registration and Identification We ask that you Sign the volunteer register on arrival and wear your volunteer identification badge (ID) Record departure time on leaving and remove your ID badge. Where provided, wear your uniform or apron when on duty Each member of staff and all volunteers are issued with an identity badge, which must be worn at all times within the precincts of the organisation. This strengthens security control in the organisation, particularly in restricted areas and enables easier identification of staff and volunteers in dealing with clients, the public and other staff members. Staff and volunteers must not deface this badge. The loss or accidental damage to your badge should be reported to the volunteer office immediately. Appearance Volunteers are requested to wear neat casual clothes and protected footwear (covered toe) non-slip flat soles. ID badge to be clearly displayed. Jewellery should be kept to a minimum for both security, safety and hygiene reasons. Strong perfume should not be used. Long hair should be neatly tied back. Change of Address and Contact Details We ask you to notify the Volunteer Coordinator of any change of address or telephone number. Family/Friends As a volunteer performing duties at NHW, no family members or friends are to be brought into the work area. Leave of Absence Notification of leave of absence should be made in writing to the Volunteer Coordinator at least 1 month prior to expected absence. Discipline Procedures These are in accordance with NHW policy Discipline & Warnings NHW0000205. All volunteers are subject to this policy. Resignation Should you decide to resign, notification in writing should be sent to the Volunteer Coordinator giving at least 4 weeks where possible and your volunteer identification badge must be returned. Fire and Evacuation Training All volunteers are required to attend the above training as part of their orientation to the organisation. Volunteers are to familiarise themselves with emergency procedures codes attached to ID badge and the evacuation procedures relevant to their local working area. NHW0001374 03/15 Page 2 of 3
Security To protect your belongings, it is advised not to bring items of value with you, if you need to bring anything that needs to be locked away, please ensure this is arranged with your Department Volunteer Supervisor. NHW does not take responsibility for any losses. Code of Ethics and Patient Confidentiality When a client enters NHW the organisation assumes an obligation to keep in confidence all that pertains to the client and his or her affairs. This obligation rests with all individuals working at NHW including employees and volunteers. Except in the course of your duties, you are therefore obliged to refrain from discussing any patient or information regarding a patient with any person. As a volunteer of NHW you are also required to comply with the Code of Behaviour for staff of NHW. Non-compliance with NHW s code of ethics and confidentiality may include: Repeating remarks overheard about the organisation, other staff members, volunteers or clients Answering questions about a client s condition Comparing similar medical conditions Reading a client s case notes or chart Performing duties outside your area of responsibility Giving professional advice Being critical of, or interfering with, organisation s operations of its business Accepting money or significant gifts from a client or family Giving money or significant gifts to a client or family Imposing your own beliefs (including religious) or attitudes on anyone in the hospital Becoming personally involved with clients and families Taking photographs of clients Giving personal details to a client for them to contact you at home or accepting client s details in order to contact them Under no circumstances may any unauthorised statement be made to the press, radio or television. Any requests from the media should be referred to the person in charge of the area. Awards Service by volunteers to NHW is greatly appreciated by members of the board of management, the executive team and hospital staff. An annual Thank You Reception is held to recognise this service. Amenities There is parking within the vicinity of NHW and also a staff carpark that is also available to volunteers. Food can be purchased from the Coffee Shop. Volunteer Office Staff The Volunteer Service s Team is available to ensure all volunteers enjoy their contact with NHW. If uncertain about anything in relation to your role do not hesitate to contact any member of the team to discuss. NHW0001374 03/15 Page 3 of 3