Program:

Community Area/Location:

Placement Supervisor:

Phone:

Email:
Volunteer Activity Description

Insert title of volunteer position

Purpose: state purpose/desired outcome(s) of volunteer activity. (Note: Volunteer Services will work with you to enhance the purpose.)

Responsibilities: Include the tasks/responsibilities of the volunteer role. Below is a sample of some generic tasks. The more details provided the better.

May include:

Working with files

Photocopying

Assembling charts or information packages

Mail-outs

Telephone duties

Computer work including word processing, spreadsheets and/or Internet.

Information gathering

Other:explanation and demonstration to the group as requested

Client/Patient support may include:

Escorting clients and leading them through the process.

Welcome/familiarize/support clients/patients (describe how)

Registration

Client assistance (describe how)

Tidying area

Needs Assessment/Satisfaction Surveys

Other:

Necessary Qualifications and/or Skills: Include all necessary skills and qualifications needed to perform the role. Below are some suggestions.

May include:

Physically able to perform tasks which includes…

Manual dexterity to perform…

Ability to work with minimum supervision

Ability to follow directions and attention to details

Ability to understand, give direction and express oneself in English in a clear, concise manner

Organizational skills

Conscientious, Reliable

Computer skills (specify)…

Ability and comfortable with approaching people in a friendly, supportive manner

Sensitive to diverse cultures and socio economic backgrounds

Must respect the policies of the WRHA regarding confidentiality dress code.

Other:

Benefits (an opportunity to): List the benefits associated with this role. Here are some suggestions

Learn new skills

Explore careers

Gain experience in an office/healthcare environment

Provide service to others

Make a personal contribution to the improvement of community health care

Make a personal contribution to the enhancement of health care

Other:

Length of Commitment: Indicate how often the volunteer is needed and for how long (i.e. One shift a week for a minimum of 3 months).

Shifts: Indicate exact shifts including dates and times (i.e. every Thursday from 1 to 4pm)

Scheduling Standards: Indicate how many volunteers are needed (i.e. 1 volunteer per shift)

Supervision: Include name of placement supervisor(s)

Orientation/Training: Volunteer Services staff and/or designate will provide general WRHA and Volunteer Services orientation. Placement supervisor will provide all necessary training required by this activity including recommended food handling practices.

Risk Level/Screening Standards: All volunteer roles require an interview and 3 reference checks. Please refer to the document on Insite “Risk Level/Screening Standards” to determine if any other screening checks are needed for this role.

Activity Description Approved by:

Community Area/Program Director	Date

Manager, WRHA Volunteer Services	Date

Placement agreement

I agree to be responsible for providing the volunteer(s) with appropriate training and supervision in a respectful environment. I will communicate any changes to this placement in a timely way to Volunteer Services.

Placement Supervisor	Date

Volunteer Agreement

I agree/commit to perform my duties, as provided in the activity description, to the best of my ability. I understand that it is important not to go beyond the responsibilities, outlined in the volunteer activity description, and I will confine my volunteer activities as so defined by Volunteer Services of the Winnipeg Regional Health Authority (WRHA).

Volunteer Signature	Date