Volunteer Form
EIXSYS Healthcare System (EHS) is a community‐based non-profit tax exempt charity organization as described in Section 501(c)(3) of the Internal Revenue Code; EIN 46-5413288, founded on being non-denominational and fostering a multi-cultural environment. Through volunteers EHS provides healthcare services; EIXSYS Healthcare System offers FREE preventative healthcare medical checkups\follow-ups to those that fall under 100% Federal Poverty Level. This project cannot run without the support of volunteers like you.
This application must be filled by all volunteers. All information will be kept confidential
EIXSYS Healthcare System Volunteer Program Policies and Procedures
Introduction
A. Mission: EIXSYS Healthcare System (EHS) is dedicated to improving the quality of healthcare for all citizens, with an emphasis on preventative care, while lowering overall healthcare costs. EHS seeks to accelerate current “best practice” adoptions in order to dramatically lower costs and enhance quality of care and outcomes. We will provide thought leadership and implement technical systems and healthcare processes that will reduce administrative and clinical costs by building a modern healthcare delivery system. We are moving ahead to improve healthcare practices through preventative measures and strive towards improving quality of care through collaboration and coordination.
B. Volunteer/ Staff Relations: Volunteers are critical to the success of EHS, and are essential to the organization’s day-to-day operations. Volunteers and paid staff are considered partners in implementing the mission and programs of the organization, each with complementary roles to play. Designated staff can be expected to provide orientation, training, supervision, and feedback to volunteers. A volunteer is anyone who, without compensation or the expectation of compensation, performs a task at the direction of and on behalf of the organization.
C. Equal Opportunity Policy: EIXSYS Healthcare System maintains a strong policy of equal volunteer opportunity. We recruit, accept, train, promote and dismiss volunteers on the basis of personal competence and position performance, without regard to race, creed, color, religion, sex, sexual orientation, age, marital status or handicap.
Volunteer Rights and Responsibilities
Volunteers are viewed as a valuable resource to this organization, its staff, and its clients. Volunteers shall be extended the right to be given meaningful assignments, the right to be treated fairly, the right to effective supervision, the right to full involvement and participation, and the right to recognition for work done. In return, volunteers shall agree to actively perform their duties to the best of their abilities and to remain loyal to the goals and procedures of the agency.
Volunteer Release and Waiver of Liability
Volunteer releases waiver of liability to EIXSYS Healthcare System, a non-profit 501(c)(3) organized and existing under the laws of the State of Texas, and each of its directors, officers, employees, and agents. The Volunteer desires to provide volunteer services for EIXSYS Healthcare System and engage in activities related to its operational, administrative and clinical functions.
The Volunteer understands the scope of the Volunteer’s relationship with EIXSYS Healthcare System is limited to a volunteer position and that no compensation is expected in return for services provided by the Volunteer, that EIXSYS Healthcare System will not provide any benefits traditionally associated with employment to the Volunteer, and that the Volunteer is responsible his/her own insurance coverage in the event of personal injury or illness as a result of the Volunteer’s services to EIXSYS Healthcare System.
1. Waiver and Release: I (Volunteer) release and forever discharge and hold harmless EIXSYS Healthcare System and its successors from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the services I provide to EIXSYS Healthcare System. I understand and acknowledge that this release discharges EIXSYS Healthcare System from any liability or claim that I may have against EIXSYS Healthcare System with respect to bodily injury, personal injury, illness, death, or property damage that may result from the services that I provide for EIXSYS Healthcare System or occurring while I am providing volunteer services.
2. Insurance: Further I understand that EIXSYS Healthcare System does not assume any responsibility for or obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability benefits or insurance of any nature in the event of injury, illness, death or damage to my property. I expressly waive any such claim for compensation or liability on the part of EIXSYS Healthcare System beyond what may be offered freely by EIXSYS Healthcare System in the event of such injury or medical expenses incurred by me.
3. Medical Treatment: I hereby release and forever discharge EIXSYS Healthcare System from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during my tenure as a volunteer with EIXSYS Healthcare System.
4. Assumption of Risk: I understand that the services I provide to EIXSYS Healthcare System may include activities that may be hazardous to me. As a volunteer, I hereby expressly assume the risk of injury or harm from these activities and release EIXSYS Healthcare System from all liability for injury, illness, death, or property damage resulting from the services I provide as a volunteer or occurring while I am providing volunteer services.
5. Photographic Release: I grant and convey to EIXSYS Healthcare System all rights, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by EIXSYS Healthcare System in connection with my providing volunteer services to EIXSYS Healthcare System.
6. Other: As a volunteer, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that this release shall be governed by and interpreted in accordance with the laws of the State of Texas. I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.
Volunteer Program Procedures/Development
1. Application Form: Prospective volunteers are required to complete an application form for consideration in the volunteer program.
2. Interviewing/Screening: Prior to being assigned or appointed to a position, all volunteers will be interviewed to ascertain their suitability for, and interest in, a position. The interview will offer the opportunity to learn more about the prospective volunteer, and give the prospective volunteer the opportunity to learn more about the organization. Volunteers will also be given the opportunity to ask any questions they may have about the position. Background and reference checks may also be required for volunteer positions within EHS.
3. Orientation and Training: All volunteers will receive a general orientation on the nature and purpose of the agency, all pertinent policies and procedures, and to the work to which the volunteer has been assigned. Volunteers will receive specific training to provide them with the information and skills necessary to perform their volunteer assignment. All volunteers will have a position description for the work they perform on behalf of EHS.
4. Supervision: Every volunteer will have a clearly identified supervisor who will be responsible for support and direction. The supervisor will be responsible for the management and guidance of the work of the volunteer, and shall be available to the volunteer for consultation and assistance.
5. Feedback and Evaluation: Volunteers shall receive periodic evaluations to review their work and progress. Evaluations will include an examination of the volunteer’s performance of position responsibilities and a discussion of any suggestions the volunteer may have concerning the position or volunteer program.
6. Recognition and Opportunities for Advancement: Volunteer service is very valuable to EIXSYS Healthcare System and we will recognize volunteers on both an informal and formal level. Exemplary volunteers will be made aware of other volunteer opportunities available for which they may be interested in participating, and will be given opportunity for advancement for other volunteer positions.
7. Volunteer Record Keeping System: A system of records will be maintained on each volunteer with the organization. The record will include volunteer application, volunteer agreement, dates of services, position held, duties performed and evaluation of work.
8. Scheduled Volunteer Time/ Record of Volunteer Hours: A volunteer sign-in form will be present at each volunteer program or event, and volunteers should sign in and out each time they work on any project. Volunteers must be accountable to uphold their commitments to volunteer at established times/places.
Volunteer Conduct
1. Job Description: A position description will be specifically defined for each volunteer or group of volunteers. Each volunteer will receive a copy his/her position description during the orientation program.
2. Standard of Conduct: The lasting impression that volunteers make on those they serve and work with reflects directly on all staff, volunteers and board members of EIXSYS Healthcare System. All words and deeds should help build our volunteer program and its reputation for quality.
3. Absenteeism: Volunteers should do their best to be present and on time for each event or clinic for which they are scheduled. If you know that you will be late or absent, please contact the person in charge of the event or your Clinic Manager at least 24 hours before you are expected to come, or as soon as possible, so that alternate plans can be made.
4. Grievance Procedure: Volunteers and staff are expected to act professionally and in accordance with their position descriptions. Should a volunteer have a grievance concerning their work environment, they should report it promptly to their supervisor or Volunteer Coordinator. Every effort will be made to achieve speedy and effective resolution, and all complaints will be treated confidentially.
5. Discontinuation of Volunteer Service: If you wish to leave your volunteer service for any reason, please contact the Volunteer Coordinator so that appropriate arrangements can be made. As a volunteer, you have the right to terminate your volunteer service for any reason. EHS reserves the same right.
6. Media Conduct: Please be careful not to represent yourself as a spokesperson or representative for the organization under any circumstances without prior approval. Only the board members EHS staff and Clinic Manager serve as spokes-people for EIXSYS Healthcare System.
7. Alcohol/Drugs: When participating in EHS activities, volunteers are prohibited from purchasing, transferring, using or possessing illicit drugs, alcohol, or prescription drugs in any way that is illegal. Implementing this policy provides a drug and alcohol free work place in order to ensure a safe, healthy, and productive environment for all volunteers and employees. If caught or suspected of breaking this policy, disciplinary actions up to and including termination will result.
8. Harassment Policy: Volunteering should be an enjoyable experience. Harassment is not only illegal, but it also creates uncomfortable conditions and an unpleasant experience for everyone involved. Any volunteer who feels harassed should speak to the Volunteer Coordinator in an attempt to reach a solution.
9. Dress Code: When volunteers are working on behalf of EHS, each individual serves as a visible representative of our organization. Please be sure that your dress reflects a clean and neat appearance. Shorts (except knee-length shorts), tank tops, sleeveless shirts, mesh shirts, cutoff shirts, sweat pants, jogging suits, caps, ripped jeans, flip-flops and T-shirts with controversial slogans or images are not appropriate. For those working as Medical Assistants, Nurses, or Physicians, please remember no open-toed shoes during clinic and ensure your nails are trimmed to appropriate lengths. In addition, please ensure that there are no visible tattoos.
10. Confidentiality: As a volunteer at EHS, you may have access to confidential information (information regarding medical treatment or diagnosis, patient identifiable information, financial information, contractual arrangements or other transactions). Volunteers must ensure that the agency’s official board approved confidentiality policy is followed. Volunteers are required to sign the confidentiality policy receipt form prior to beginning their volunteer service.
11. Conflict of Interest: It is the policy of EIXSYS Healthcare System to avoid potential and actual conflicts of interest in all of our efforts. EHS abides by a board approved conflict of interest policy.
12. Proselytizing: EHS is a non-political, non-religious organization. Program participants, staff and volunteers hold a variety of political, social, religious, and personal beliefs. Volunteers must be respectful of the views and opinions held by others with whom they come in contact while volunteering with the organization. Volunteers must refrain from advocating or proselytizing for any specific political, social, and/or religious beliefs in these situations.
13. Partisanship: EHS is a non-political, non-religious organization. While working on behalf of EHS, volunteers must never present partisan information (supporting or endorsing political parties or candidates for office) in accordance with our organization’s 501(c)(3) status.
14. Respect of Facility Partners: EHS is a non-political, non-religious organization. EHS often partners or contracts with organizations and utilizes their facilities for clinics, health fairs and other events. Volunteers, at all times, must demonstrate respect of the rules, codes of conduct and religious beliefs when working in all such facilities.
15. Change of Placement: If you wish to seek a change in your volunteer position or placement, please see the Volunteer Coordinator. Assignment to a new volunteer position may require additional screening, background checks, training, and application acceptance.
16. Reimbursement of Expenses: In certain situations, volunteers may be eligible for reimbursement of actual out of pocket expenses. Such expenses must be pre-approved by the Volunteer Coordinator and appropriate documentation must be submitted.
Safety and Liability
1. Safety: Although we do our best to provide safe conditions for our volunteers, we count on volunteers to be the best protector of their own personal safety. Volunteers should always be aware of where they are and what they are doing. Volunteers should pay particular attention to safety instructions and proper equipment use. Volunteers should speak up if they have a safety concern and report any injuries to the person in charge as soon as possible.
2. Legal Liability: When a volunteer acts as a representative of the agency, acting on the agency’s behalf and with its authority and within the scope of the volunteer’s duties, the agency may be held vicariously liable for the actions of the volunteer. However, liability is based upon the personal acts of a person, so the volunteer may also be liable for his or her actions.
3. Certificate of Ability: Any potential volunteer who indicates that they are under the care of a physician for any physical or psychological ailment which might impede their ability to work may be asked to present a certificate from the physician as to their ability to satisfactorily and safely perform their duties. Any volunteer who, after accepting an assignment with the organization, enters a course of treatment which might adversely impact upon the performance of their volunteer duties, should consult with the Volunteer Coordinator.
Policy and Procedure Acknowledgment
I have read, and understand, all the policies and procedures set forth by EIXSYS Healthcare System. I will adhere to these policies and procedures.
Commitment to Serve
I understand that as a volunteer or staff member for Eixsys Healthcare System, Inc I have a moral responsibility to ensure that EIXSYS Healthcare System (“Organization”) does the best work possible in pursuit of its goals. I believe in the purpose and the mission of the Organization and I will act responsibly and prudently as its steward.
I do hereby declare and affirm my willingness to assume the responsibilities as summarized below:
Attendance:
I understand that this COVID-19 Vaccination project is about a three-to-four-month long project to vaccinate the local population of Central Texas. The Organization plans to vaccinate the local population 4 days a week with 4 hours a day. I commit to being available onsite or remote, as the Organization requires, at least one day a week to support the vaccination project and fulfil My Duties as identified below. I understand that if I am unable to attend on a scheduled date, one day prior notice is required in order to find a suitable replacement. I understand that repeated unexcused absences may constitute a forfeiture of my project duties or termination from the Organization.
Duties:
Medical Director/Medical Provider
I will oversee the vaccination process as a Medical Director/Medical Provider and be available to respond to any adverse reaction to the COVID-19 vaccine, treat the individual as a patient and sign-off on medical charts. I will also make all efforts to recruit other medical providers to volunteer and support this global effort to end this pandemic. I will safeguard and transmit patient records safely and securely.
Vaccinator
I will manage vaccine rendering in accordance with guidelines issued by CDC and Texas HHSC.
Medical Records Manager
I will manage upload and create encounters for all patients if required. I will safeguard and transmit patient records safely and securely.
Staff Manager
I will recruit, train and assign key staff to manage on-site station management and process flow.
Clinical/Operations Manager
I will oversee all clinical operations and waste management. I will safeguard and transmit patient records safely and securely. I am responsible for the safety and security of the patients, volunteers and staff. I will keep sites in line with all OSHA and HIPAA requirements.
General Volunteers
I understand that my role may vary as needed by the organization. I understand that I am under the general direction and supervision of the Staff Manager and/or Operations Manager. I understand that my duties may include setup and breakdown of sites, security management, traffic flow management, and translation among others. I also understand that I may be required to lift objects up to fifty pounds or operate machinery during the course of my shift.
Policy:
I will consider, approve, and support management policies that promote and enhance the mission of the Organization and I will avoid intruding into duties not assigned to me. I will stay informed about the Organization. I will participate in and take responsibility for making decisions on issues and policies that are related to my expertise and Duties. Patient privacy is to be guarded at all times. Access to patient medical information should be minimized to volunteers and staff that have a valid reason for accessing. I will execute my Duties with safety in mind always.
Public Relations:
I will positively interpret and represent the Organization’s work and values to patients, other organizations, associations, elected officials, businesses, and individuals. I will act in the best interests of the organization and excuse myself from discussions and votes where I have a conflict of interest. I will work in good faith with staff and other project leads as partners towards achievement of our goals. I will not speak to the media about the Organization's work or projects without the approval of the Organization’s president.
I also understand:
- If I do not fulfill these commitments to the COVID-19 Vaccination project, I will expect the project management lead to call me and discuss my responsibilities with me.
- Any expenses associated with attendance at events or meetings are my sole responsibility unless prior approval has been given.