Volunteer Registration Form

Initial contact date _____/_____/______Interview Date______/______/______

Volunteer role/s Placement Date______/______/______

Police check No.:______Date: ______Resolved Date:______OS Status (if applicable)

Handbook & PD Referred to Staff Supervisor Email list Card/Database Reference Check Parental

Permiss.

(October 2013 Volunteer Alliance, Ashburton Support Services)



VOLUNTEER ALLIANCE ORIENTATION - IMPORTANT PERMISSIONS and AGREEMENTS

(Please read carefully, tick the boxes as applicable, and SIGN)

AIMS: Volunteer Alliance is committed to providing the best quality services to our agencies’ clients.

- We follow the Dept. of Health HACC (Home and Community Care) Standards and Active Service Model

(ASM means a client-centred approach, to maximise autonomy, independence, social activity and capacity)

- We aim to recruit, welcome, and place, suitably skilled and reliable volunteers

- We have a Duty of Care to our clients: to avoid harm; take responsible care; report any concerns to staff

- We share a commitment to making a SAFE, RESPECTFUL, and INCLUSIVE workplace

In support of these aims, I understand and agree to the following:

I ca I will raise any questions, suggestions, concerns or complaints with my agency’s staff supervisor.

I understand that the member agencies are Equal Opportunity workplaces and services. We do not tolerate any form of bullying or harassment, including sexual harassment. We welcome diversity & do not discriminate against service-users, staff or volunteers based on: gender, race, religion, politics, age, sexual orientation, disability, etc. I support the organizational goals of being welcoming and inclusive.

In a Privacy Legislation (Privacy Act 1988, 2000 Vic.) I understand the policy relating to privacy and confidentiality. I agree to keep client, staff and volunteer information private and confidential. My own information will be stored securely and treated confidentially by staff. I can ask to access it at any time.

I won’t give my own tel. no. to a client.

I understand Safe Manual Handling and Occupational Health and Safety principles in my

workplace, including no heavy lifting. I will report any incident or hazard to my supervisor.

Food Safety and Infection Control – I understand the importance of personal hygiene, washing hands frequently, hats, gloves, cleanliness and food-safety principles in the kitchens, and with clients.

Police Record Check permission - I authorize the organization to undertake my standard volunteer police check, which may include advising the Department of Human Services of any disclosable records resulting from the Police Check. A new check will be required every 3 years.

Overseas? - I have no disclosable police record (criminal history) to declare from time I have spent outside Australia

In a health emergency I authorise the agency I am placed with to take whatever action is deemed appropriate in seeking medical treatment for me. I give permission to release my medical information to supervising staff at the agency/ies for which I am volunteering, and to medical personnel. I agree to pay for all medical bills and expenses incurred on my behalf.

I give my permission for the organisation to use the information I have supplied for management purposes such as: contact lists, statistics, reports. I also give the agency permission to use photographs with my image. (media release)

I understand the basic principles of the HACC Active Service Model (ASM) – to maximize the client’s own independence, engagement and capacity. I agree to read my PD and Handbooks & follow the policies, principles and procedures of the agency I am placed with as a volunteer.

Following this orientation & my three session on-the-job training & trial period, I am willing to commit to a minimum of six months regular volunteer work. I agree to keep informed by attending ANNUAL TRAINING, reading VOLUNTEER NEWSLETTERS, and other volunteer NOTES. I understand the need for reliability and continuity in my volunteering. (reference only after six months).

- I understand that a breach of these agreements may result in the termination of my services

- I understand that staff reserve the right to end a role at any time if they find me unsuited to it.

Signed: Date: ______/______/______

Print Name ______

VOLUNTEER DRIVER’S DECLARATION

DRIVING DETAILS (Only if doing driving duties)

Drivers License Number:

Expiry Date: ______/______/______

Do you have any license Endorsements or Restrictions?

(Eg: Glasses, Automatic only, Heavy Vehicle)

Insurance on YOUR car: Comprehensive/ Third Party Property (Please circle)

I understand and acknowledge that while volunteering with Volunteer Alliance Agencies (Ashburton Support Services, Samarinda Aged Care, Alamein Neighbourhood Learning Centre) I am covered by a limited personal accident insurance policy through the Department of Human Services/Health. This insurance does not cover children accompanying their volunteering parents on their work.

I understand that Volunteer Alliance and agencies do not provide an indemnity for damage to my vehicle or for injury occurring to other persons or property through the use of my vehicle whilst performing my role as a volunteer driver.

I agree that:

1. I will maintain a current driver’s licence, subject to an annual check.

2. I will keep my vehicle registered, roadworthy and insured

3. I will provide annual proof of registration and insurance renewal

4. I will keep my vehicle in a safe and clean condition in accordance with Meals on Wheels safe food handling requirements, or suitable for clean and safe client transport

5. I give permission for my vehicle to be inspected periodically by agency staff

6. I agree to notify my insurer of my intention to use my vehicle for voluntary work

7. I assume responsibility for all traffic offences and fines incurred whether or not they were incurred while performing my volunteer role

8. I will immediately notify my agency supervisor of any change to my health and/or any medication I am taking which may affect my ability to safely operate a motor vehicle

9. I will report any accident or injury I incur while performing my volunteer role to my agency supervisor within 24 hours, and complete an Accident Report.

10. I understand the importance of safe driving for the clients in my care, and myself.

Signed ______Date______

FOLLOW UP (Office Use Only)

Reference Check

1. Name ______Date ______Comments______

______

2. Name ______Date ______Comments______

______

Support Follow Up (see volunteer database)

Date / Comments

Training undertaken: - (see training register)

Date / Course

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