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Volunteer Orientation Checklist
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First name:
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Last name:
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Email:
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I have completed and returned all appropriate forms and tests as further evidence of my understanding, agreement, and commitment:
Standards of Behavior
Confidentiality Agreement
OSHA/Safety Test
Infection Control Test
HIPAA Training Acknowledgement
HIPAA & CMS Compliance Test
Social Media Guidelines
I understand there are additional items I will be required to turn in to complete my volunteer orientation including, but not limited to medical documentation. I shall submit to examinations and annual retesting as necessary as a condition of my volunteer service, which may include:
Skin tests
Chest x-rays
Appropriate laboratory tests
Immunizations
*
To the statement above:
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I have read and understand the assignment descriptions for the volunteer assignments I am interested in, and I agree I am able to and willing to perform all duties indicated.
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I have read and understand the Mission, Vision and Values of Crossing Rivers Health.
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I have reviewed the information on Diversity. I understand and agree to be respectful of all staff, volunteers and customers.
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I have reviewed the information on Journey of Excellence and Service Excellence. I understand excellence must be the priority for any health care, and at Crossing Rivers Health we combine the professional service excellence with outstanding personal service.
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I have reviewed the information on Customer Service. I understand great customer service is the number one priority.
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I have read and understand the Guidelines for Effective Communications for All Age Groups.
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I have read and understand the Volunteer Code of Conduct, Volunteer Responsibilities, and Volunteer Policies & Procedures.
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I have read, understand and agree to strictly abide by all rules and policies regarding HIPAA and Confidentiality.
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I have read and understand the proper Infection Control procedures including hand hygiene, standard precautions, isolation categories, and blood borne pathogens.
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I have read and understand the OSHA & Safety Information, including Emergency Conditions & Basic Staff Response, and know my role in case of an emergency.
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I understand that I will be given an identification badge and I am to wear it any time I am on duty, and I agree to return the badge to Volunteer Services when my service is complete.
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I have reviewed the dress code policy and agree I will be in proper attire any time I am on duty.
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I do not agree
*
I have completed and returned all appropriate forms and tests as further evidence of my understanding, agreement, and commitment: Confidentiality Agreement, OSHA/Safety Test, Infection Control Test, HIPAA Training Acknowledgement, HIPAA & CMS Compliance Tests, Social Media Guidelines, and Standards of Behavior.
Required
Agree
I do not agree
*
I understand there are additional items I will be required to turn in, including by not limited to medical documentation. I shall submit to examinations and annual retesting as necessary, which may include skin tests, chest x-rays, and appropriate laboratory tests and/or immunizations as a condition of my volunteer service.
Required
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Date:
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I understand that by responding and submitting an answer to any of these questions it is the equivalent of actually “signing” my name to the statement(s) that precede(s) it. My electronic signature will constitute my “original” signature as well as my Acknowledgment and Certification of the applicable statement(s) when used or printed. A signed copy of this form will be maintained in my volunteer file and I can receive a copy at any time from my Volunteer Services office.
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