DearProspectiveVolunteer:
Thankyouforyourinterestinvolunteering atAspenValleyHospital. Our volunteersprovideavarietyofessentialservicestoourpatientsandstaffandare anintegralpartofourteam.
Enclosedpleasefindanapplication, aconfidentialityagreement,and authorizationforastandardbackgroundcheck. Aftercompletion, pleasereturn to:
AspenValleyHospital
Volunteer Coordinator
0401CastleCreekRoad
Aspen, CO 81611
Alsoenclosedisalistofthedepartmentsinthehospitalwhereourvolunteers work. Althoughwe askyoutotelluswhichunitsinterestyou,ifthere isagreater needinanotherdepartment,wemayaskyoutoconsideracommitmentina departmentother thanyourfirstchoice.
Weinvestsignificantresourcesintheorientationofourvolunteers,sopleasenotethatweaskforaone-yearcommitmentatfourhoursperweek. Ifyouareunabletomakethatcommitment,pleasedonotsubmityourapplicationatthis time. Ifyoucancommit,afterwereceiveyourapplication andcontactyour references,youwillbecalledforaninterview.
Thankyouforyourinterest,andIlookforwardtohearingfromyou.
Sincerely,
Director,CommunityRelations
VOLUNTEERAPPLICATION
Name:
Date:______
MailingAddress:
E-Mail Address:______
Telephone:Home:
Cell:
Work:______
Listlanguages inwhichyou arefluent: ______
Doyoulivefull timeinAspenor theValley: Yes
No
Pleaselistmonths,days andtimes you are availabletovolunteer:
ListWorkExperience:
Date(s)WhereYourPosition/Responsibilities
List Volunteer Positions:
Date(s)WhereYourPosition/Responsibilities
Listafewofyour interests,skills, etc., whichmaybe ofvalueas anAVH Volunteer:
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Areyou abletocommittobeingavolunteerfor atleastoneyear and4 hours per week?
Yes
No (pleaseexplain)
Is thereaparticulararea orunitinthehospital whereyouwould prefer towork?
No
Yes(pleaseindicate)
Areyouinterestedinpossiblefutureleadership opportunities withintheAVH Volunteer
organization?Yes
No
Areyouwillingtocompleteahealthhistoryinterviewand betestedforTBandrubella?
Yes
No
Canyoumakeyourself availabletoattenda daylonghospitalorientationsessionrequiredbythe
Hospital? Yes
No
Pleaselist,as references,two peoplewhoknow youinaworkingor volunteer situation:
Name:
Phone:
WorkRelationship:
Name:
Phone:
WorkRelationship:
PleaselistnamesofanyAVH volunteers withwhomyou areacquainted:
I herebycertifythattheabovestatements Ihavemadearetruetothe bestofmyknowledge:
Signature/Date
ApplicationrevisedFebruary 2014
AVHVOLUNTEER CONFIDENTIALITY AGREEMENT
IMPORTANT:Pleaseread allsectionsbelow.If youhaveany questionsregardingthisAgreement,pleasediscuss withtheDirectorof CommunityRelations. TheVolunteer recognizesand acknowledgesthat:
1.TheservicesAspenValley Hospital performsare confidential;
2.ToenableAspenValleyHospitaltoperformtheseservices,its patients,employeesand physiciansfurnish usconfidentialinformation concerningtheiraffairs;
3.Thegoodwillof the hospitaldepends,amongother things,upon itskeepingsuch servicesand informationconfidential;
4.Byreason of the Volunteer’sduties,theVolunteermaycomeintopossessionof information concerningtheservicesperformedbyAspenValleyHospitaleven though theVolunteermaynot takeany directpart inorfurnish theservicesperformed.
TheVolunteeraccordinglyagreesthat, exceptasdirectedby AspenValleyHospital,the Volunteerwill not,atanytimeduringor afterhis/herservice atAspenValley Hospital,disclose anyof suchservicesorinformationtoanypersonwhatsoever. Norshall the Volunteerpermit any personwhatsoeverto examineormakecopiesof any reportsor otherdocuments coming intohis/herpossessionor underhis/hercontrol,recognizingthat thedisclosureof information maygive risetoirreparableinjurytothepatientor totheownerof suchinformation,and that accordingly,thepatientor ownerofsuchinformationmayseekanylegalremediesagainstthe Volunteerwhichmaybeavailable.
Ihavereadallof theabove Sectionsof thisAgreement,andIunderstandthem.
Name(Pleaseprint)
SignatureDate
BACKGROUND CHECK DISCLOSUREAUTHORIZATION
Disclosure
Asanapplicantforemployment, volunteershiporcurrentemployeeofAspenValleyHospital,youareaconsumer withrightsundertheFairCreditReportingAct. Whenanyofthefollowingcircumstancesexist,AspenValley Hospitalmaychoosetoobtainanduseinformation containedineitheraconsumerreportoraninvestigative consumerreportfromaconsumerreportingagency aboutyou: (1)whenconsideringyourapplication for employment/volunteership,(2)whenmakingadecisionwhethertoofferyouemployment/volunteership,(3)when decidingwhethertocontinueyouremployment/volunteership(ifyouarehired),or(4)whenmakingother employment-relateddecisionsdirectlyaffectingyou.
Forexplanationpurposes,a“consumerreportingagency”isapersonorbusiness, which,formonetaryfees,duesor on acooperativenonprofitbasis,regularlyassemblesorevaluatesconsumercredit informationorother information onconsumersforthepurposeof furnishingconsumerreportsto others,suchasthisorganization.
A“consumerreport”meansanywritten,oralorothercommunication ofanyinformationbyaconsumerreporting agencybearingonyourcharacter,generalreputation,personalcharacteristics ormodeoflivingwhichisusedor expectedtobeusedorcollectedinwholeorinpartforthepurposeofservingasafactorinestablishingyour eligibilityforemploymentpurposes.
An“investigative consumerreport”meansaconsumer reportorportionthereofinwhichinformationonyour character,generalreputation,personalcharacteristicsormodeoflivingisobtainedthroughpersonalinterviews withyourneighbors, friends,orassociatesreportedonorwithotherswithwhomyouareacquaintedorwhomay haveknowledgeconcerninganysuchitemsof information.
Intheeventaninvestigative consumerreportisprepared,youmay requestadditionaldisclosuresregardingthe natureandscopeoftheinvestigationrequestedaswellasawrittensummary ofyourrightsundertheFairCredit ReportingAct.
Authorization
Bysigning below,Iherebyauthorize all entitieshaving information about me,including present and formeremployers, criminaljusticeagencies,schools, andcredit reporting agencies(forresidencyverification only),to releasesuch information to business Information Group/Certiphi Screening,Inc./TrueScreen Inc.
AuthorizedSignature
Date: ____
FullName: MaidenName: _
ForIdentificationPurposesOnly
DateofBirth:
SocialSecurityNumber: _
CurrentResidentAddress:
TelephoneNumber: _
AVHVolunteer Opportunities andDuties
COMMUNICATIONSDEPARTMENT:
Volunteersassignedtothisunitmeterand sortallof thehospital’s outgoingmail,distributeincomingmailand forward mail. Theycopy,compileand deliver charts. Volunteersdeliver mail forpatientsto thePatientCareUnitdesk.
Hours
Year Round: 10:30 AM–2:30 PM Mondaythrough Friday
Unitmeetingswill be heldasneeded. Attendanceofall volunteersisexpected attheunit meetings.
EMERGENCYROOM:
Dutiesincludegreeting patientsastheyarrive,relaying informationon patientcondition tovisitors,crowdcontrol,making beds,replenishing charts,making photocopies,taking patientstothedeskupon release,moving patientsto physical therapyor patientcareunitasrequested,updating familiesof patientsin thewaiting room,restocking,and answering thetelephoneasneeded. Volunteersprovide varioustypesof assistancetotheunitmanager,nursesand doctorsasrequested.
Hours
Winter shift: 11:00AM–4:00 PMMondaythroughSunday
Summer shift: 11:00AM –4:00 PMtwodaysperweek
GIFTSHOP:
Volunteerssellitemsfromthegiftshop and replacewhattheysellfromthestoreroom. Theyfollow all opening and closing procedures and help with other duties as requested during their shift.
Hours
Year-roundweekly hoursarein twoshifts:
10:00AM- 1:30 PMand 1:30PM–5:00 PMMondaythrough Friday
Weekend WinterHours: 12:30 PM-4:30PM Saturdayand Sunday
Monthlyunitmeetingsare held asannounced and attendanceisexpected atthesemeetings.
HOSPITALITY:
Volunteers operatefromthefront desktogreetpatientsand visitors. Theyescortthe unfamiliar, help those that need assistance, and give directional advice. These volunteers tidy the main lobby and the same-day surgery lobby as needed. Often, the volunteers will serve water, coffee, or tea. The ideal volunteer is outgoing and able to navigate all parts of the hospital (often several times a day.)
Hours
Year round: 10:30AM–2:30 PM
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PATIENTCAREUNIT:
Volunteersworkwiththenursing staff in thePCU,OBand ICU unitsand haveanopportunitytointeractwith patients. Dutiesincludeaccessing limited patientinformationvia computer,distributing newspapers,refilling watercontainers,providing nourishmentasrequested,helping withmeal selections,watering plantsand restocking bedside drawers. Volunteersreplenishrefrigeratorslocated in thePCU,OB,ICUand ERkitchensand assistthekitchen staffwhen needed.
Hours
10:30AM–3:00PM Sundaythrough Saturday
Unitmeetingsheld asneeded.
SAMEDAYSURGERY/OUTPATIENT:
Volunteersassistthe nursesin the same-daysurgery,outpatientand specialty clinicdepartmentsin anycapacity needed. The volunteershave directinteraction withpatientsand almostevery departmentin thehospital. Dutiesincludetransporting patientstoand fromsurgery,preparingpatientmeals, disinfecting and changing beds,greeting patientsandhelping themchangeintosurgical clothing, updating patients’familieson progress,restocking and tidying theunit’skitchen,waiting room, compiling charts,and generallybeing availabletorun errandsand performany otherjobsasrequested.
Hours
Year-Round9:00AM– 2:30PMMondaythrough Friday
PHYSICAL THERAPY
Volunteers assist in the following ways: placing linens in each room, checking main linen container to ensure sufficient linens for the day, cleaning equipment, returning equipment to proper locations in the gym, picking up used linens and replacing them with clean linens on mats after patient leaves, replacing cold/hot packs, obtaining newspapers for the department, tidying patient waiting area, providing patients with water as needed.
Year-Round, Hours To Be Determined
REQUIREMENTSFORALLUNITS
Each volunteeris responsible for:
•Respecting theconfidentialityof anything thatmaybeseen orheardwhileon dutyatthe hospital. Violationsof confidentialitycould result in dismissal, and place the hospital and the volunteer at legal risk.
•Attending amandatoryday-long hospitalorientation session.
•Attending thetwo(2)GeneralVolunteerGatheringsheld each year in JulyandJanuary is encouraged.
•Wearing a uniformand badge. Women aretowear avolunteer “pinnie”withother wearas required bytheindividualunit. MenaretoweartheAVH Volunteerpoloshirtswith slacks.
•Training bythe unithead inthedepartmentinwhich thevolunteerisworking.
•Working asscheduled orfinding a replacementina timelymanner.
•Completing a health historyand submitting toTB andrubella tests, as well as flu vaccination.