INDIVIDUAL VOLUNTEER APPLICATION & RELEASE FORM

Tri-State Food Bank must have an application on file for each volunteer.

Please complete all areas below and please PRINT CLEARLY.

Date: ____/____/____

Month Day Year

Name: ______ Male  Female

Street Address: ______

______

CityStateZip

Phone: (Home)______(Cell)______

Email:______

Birthday: _____/_____/_____ Emergency Contact (Name/number) ______

Month Day Year

Names & Birthdates of any minor children volunteering with you (use reverse if necessary):

Name:______DOB:_____/_____/_____ Male  Female

Month Day Year

Name:______DOB:_____/_____/_____ Male  Female

Month Day Year

How did you hear about us? (check all that apply):

___ Tri-State Food Bank website___ Newspaper

___ Flyer, brochure, etc.___ Other people

___ Other (specify):______

By signing below, I give my consent to be photographed while volunteering with Tri-State Food Bank, and hereby give my permission for any photos of me and/or the minor children volunteering with me as listed above to be used for informational and/or promotional purposes by Tri-State Food Bank. I release Tri-State Food Bank, its participating agencies and any consultants from any liability in connection with the use of such materials.

I, the undersigned hereby acknowledge my receipt of permission to volunteer for the Tri-State Food Bank. I also acknowledge my understanding that my services as a volunteer on or about Tri-State Food Bank, properties located at 801 E. Michigan Street, Evansvi1le Indiana or on one of its delivery or pick-up routes may expose me to various risks of injury or illness. In consideration of the permission and privilege allowed me hereunder to serve as a volunteer. I do hereby specifically agree and understand that I assume these risks, and agree not to hold the Tri-State Food Bank, Inc., its agents, employees, or volunteers liable for any such injury or illness.

I understand that this Waiver and Release of Liability extend to and apply to any, personal injuries, injurious results, damages or losses which I may experience or sustain while engaged in training for volunteer services or while engaged in serving as a volunteerfor the Tri-State Food Bank.

Tri-State Food Bank (TSFB) Policies/Procedures

Injury Procedures: In the event of an accident, report the injury to your immediate supervisor or management personnel. Report all injuries including minor injuries such as bruises and scrapes. Fill out an accident report provided by a supervisor.

Drug Free Work Place Policy: Tri-State Food Bank prohibits the manufacture, possession, sale or use of any controlled substance by any TSFB employee or volunteer while on TSFB premises, while working, or when representing TSFB, unless prescribed by a personal physician. Any volunteer who comes to work under the influence of drugs or alcohol shall be sent home.

Anti-Theft Statement: Tri-State Food Bank has zero tolerance for theft and if found or suspected of stealing from this environment, volunteers will be dismissed immediately. I understand that theft is "taking anything not given to me directly by TSFB's Executive Director, or their design."

Smoking Policy: Smoking is allowed on TSFB property only in designated areas and by those of legal age.

Confidentiality Statement: Volunteers understand that any information acquired (donor list, confidentiality personnel issues, dues and records, fund-raising information and strategies) shall be held in confidence and not discussed with outside parties or any without a strict “need to know.”

Privacy Policy: It is Tri-State Food Bank’s policy that all areas, including those subject to an individual’s control, i.e., a desk, file drawers, computer files, e-mail, etc., are not an individual’s exclusive province, but are the property of this company and, as such, are subject to search & seizure, at the Executive Director’s or Assistant Director's discretion.

Other Guidelines for Volunteer Service Work

  • If the volunteer is under the age of 18, a parent or guardian must come with the juvenile to enroll him or her in the program.
  • An adult (parent or guardian) must accompany children under the age of 13.
  • The Tri-State Food Bank (TSFB) has available a sign-in sheet and a computer check-in program that will be utilized. IMPORTANT:all volunteers are ultimately responsible for accurately recording their own hours worked. If you will need something signed by the food bank, you MUST sign in and out on the clipboard and the computer or we will not be able to verify your hours.
  • Volunteers will not be allowed to work while the warehouse is closed for lunch (Noon to 12:45 p.m.) nor be able to count the 45 minute lunch break towards the number of hours worked.
  • A refrigerator is available in the break room so volunteers can bring lunch. You may also sign out in order to leave the property to get your lunch at one of the local fast food restaurants.
  • You must sign out before leaving TSFB property.
  • Two 15-minute breaks are taken throughout the day at the discretion of the Volunteer Supervisor. Typically at 10am and 3pm.
  • No weapons, alcohol or illegal drugs may be brought onto the property.
  • No foul language will be tolerated.

Volunteer Orientation Information

Upon Arrival...

Check in with the Volunteer Coordinator by signing in as a volunteer both on the sign-in sheet and on the touchscreen computer. Fill out the volunteer application if this is your first time volunteering.

If you are planning on working four hours of more and will be here during our lunch time (12:00 – 12:45), lunch is on your own, but you must clock in and out for lunch..

During your volunteer time...

Two 15-minute breaks are taken throughout the day at the discretion of the Volunteer Supervisor. Typically at 10am and 3pm. You do not need to sign out during small breaks.

If you decide to take a break at a different time, please let the Volunteer Supervisor know. You may come to the office for your break. We have a cold water cooler and coffee available.

After your break is over, let the Warehouse Supervisor know you have returned.

Upon Departure...

Inform the Warehouse Supervisor you are leaving for the day.

Sign out at the office both on the paper sign-in sheet AND the touch screen computer.

Warehouse Rules...

No eating, drinking or smoking in the warehouse.

No cell phone or headphone use.

Warehouse attire includes: tennis shoes (no sandals or open toe shoes), jeans or walking shorts, shirts with sleeves.

No removing any product from the warehouse.

Emergency Procedures

Fire: Get clear of the fire and call 911, advise supervisor and go to the designated emergency waiting area.

Tornado or severe weather: If you are in the office building, go to the safe. If you are in the warehouses, stay in them. Do not attempt to come to the office building.

Snowstorm: Unless otherwise advised by management, TSFB does not close due to weather.

Bomb Threat: Get clear of the threatening area and call 911. Advise supervisor and then go to the designed emergency waiting area.

Terrorist or crazed person entering building: Inform management and do not approach crazed or threatening person.

Media crisis: Inform management immediately.

Designated Emergency Waiting Area: Outside main gate on Evans Street.Alternative (if main one is not safe) proceed west on Michigan Street toward Linwood Ave and wait at the closest point of safety. Under no circumstances should you leave the waiting area without management approval, unless area becomes unsafe and/or you are asked to leave by police, fire department or other city officials. Check in with the Volunteer Supervisor so we can account for all persons on our property.

Updated 3/27/15