Please read the following carefully and enter your initials in the box on the bottom.
- I am presently in good physical health.
- I understand that I must report any changes in my physical condition to the Volunteer Director.
- I fully understand that as a volunteer at the Jewish Home, I will sign in, wear the appropriate volunteer badge and follow the guidelines as presented in the volunteer handbook and by the director of volunteers.
- I understand that I will have to have a TB test before starting to volunteer at the Jewish Home.
- I understand that I am not covered by either insurance or workers' compensation.
- I accept the responsibility of confidentiality in dealing with residents and staff of the Jewish Home.
- I understand that volunteer hours begin at 9:30 a.m., and the volunteer time slots are 9:30 a.m. – 11:45 a.m. and/or 1:30 p.m. – 4:00 p.m.
- I understand that volunteers may not volunteer in the same unit as a family member/relative.
- I understand that I must be respectful of the residents and staff.
- I understand that requests made of volunteers by staff need to be adhered to.
- I understand that the needs of the residents take priority, and the staff of the Jewish Home has the primary responsibility to take care of those needs.
HIPPA Compliance Statement
As a volunteer at Los Angeles Jewish Home (LAJH), I understand that the resident’s Protected Health Information (PHI) is private and protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Access to resident PHI is on an “as needed” basis to do my assigned volunteer duties and responsibilities. It is my obligation to protect this information as I assist and provide volunteer services at LAJH. I am not to use, disclose or discuss any resident-protected health information for any purpose other than for my designated assignments. PHI includes, but is not limited to: personal and identifiable information such as resident’s name, date of birth, location, medical history or problem, to/for any external purpose. I will comply with this applicable legislation and the organization’s policies governing the release of patient information.
I hereby understand and agree to comply with Los Angeles Jewish Home’s privacy policies.
I hereby grant the Los Angeles Jewish Home the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, taken by the Jewish Home or freelancers hired by the Home, for Jewish Home publications, electronic reproductions (web sites) and promotional materials or any other purpose and in any manner or medium. In addition, I grant my permission to alter the same without restriction and to copyright the same.
I hereby release the Jewish Home and the photographer(s) from all claims and liability relating to said photographs.
The term “photograph,” as used in this agreement, shall mean motion picture or still photography in any format, videotape, video disc, and any other mechanical means of recording and reproducing images.