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Agreement
All adult volunteers are required to complete a background check authorization during the interview process.

I certify that the information above is correct to the best of my knowledge. I promise to serve a minimum of 50 volunteer hours within six months. I promise that I will not divulge any information that I shall see or hear, and I will keep confidential any information released to me during my experience at Beacon Health System. By my signature, I hereby voluntarily authorize and give permission to Beacon Health System to obtain a personal background check from Barada Associates, a national database firm. I understand this information will remain strictly confidential and available to me upon my request.

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Consent to Photography or Interview
I hereby authorize representatives of Beacon Health System to participate in the following activities, as indicated by checkmark:
The purpose or use of the photo, film, videotape or interview is: Website; promotional materials; marketing campaigns; volunteer rosters; newsletters; other volunteer content

I understand that I may refuse to sign this Authorization and that Beacon Health System will not condition treatment, payment, enrollment in the health plan or eligibility for benefits on the provision of this Authorization.

This authorization is valid until revoked by the signer or an authorized representative. I understand that I have the right to revoke this authorization, except if Beacon has taken action in reliance upon it. My revocation must be delivered, in writing, to Beacon Marketing, 3245 Health Drive, Granger, IN 46530.

I understand that images or information disclosed under this Authorization may be disclosed by the recipient and the information will no longer be protected by the privacy law.

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Performance Essentials

Volunteer Performance Essentials

Mutual Respect

I commit to consistently practice the following respectful behaviors:

      • I will always approach the person I have an issue with assuming good intent.
      • I will always seek to resolve problems in a collaborative and mutually respectful manner.
      • I will be mindful of individual differences, and cultural and ethnic diversity.
      • I will not participate in or listen to non-collaborative conversations regarding other members of the team. I will stop the conversation and direct the person(s) involved by saying "In respect of _____, I prefer you speak directly to them.
      • I will receive feedback in a collaborative manner.
      • If I am unable to resolve an issue with my co-worker on my own, I have the responsibility and will seek my manager's assistance to help me facilitate a positive resolution.


Standards of Conduct

I understand and will abide by the Volunteer Standards of Conduct.


Health and Illness Guidelines

I will not report for duty with any of the following symptoms and will not return until I have been symptom-free for 24 hours:

  • Cold sores (must be completed crusted over before returning)
  • Temperature of 100 degrees or greater
  • Gastroenteritis
  • Vomiting/diarrhea of unknown origin
  • Shingles, Herpes Zoster
  • Chickenpox, Varicella zoster (or exposure to)
  • All rashes when in patient care or food areas
  • Pink eye (conjunctivitis) requires eye drops for a 24-hour period
  • Scabies (or exposure to)
  • Lice (or exposure to)
  • Tuberculosis (or exposure to)
  • Draining lesions/wounds
  • Uncontrolled coughing or other respiratory symptomology


COVID

  • COVID-19 exposure: Take three days off to monitor for symptoms
  • COVID-19 positive: All three conditions below must be met in order to return:
      • - 10 days have passed since symptoms first appeared
      • - 24+ hours fever-free, without fever-reducing medicine
      • - Improvement in respiratory symptoms
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Confidentiality and Non-Disclosure Agreement

Volunteer & Vendor Statement of Confidentiality and Non-Disclosure Agreement

Beacon Health System and subsidiaries has a policy of preserving the confidentiality of medical, staff member, proprietary and other information regarding activities and treatments provided in our facilities. Policies and procedures pertaining to the release of information are established to protect the privacy of patients, staff members, prospective staff members and others, to provide this information to authorized persons for medical care, insurance and legal matters, and to protect all information from inappropriate use or disclosure. Beacon Health System's online policy and procedure manual contains the guidelines for the release of protected health information, and similar policies and procedures may be found on the Beacon Health System intranet or designated locations.

The information contained in the medical, staffing, financial, computerized and other records of Beacon Health System and subsidiaries are the property of Beacon Health System and subsidiaries. A professional, ethical and legal obligation exists on the part of Beacon Health System and subsidiaries to protect the confidentiality of the information contained in these records.

Violation of these policies and procedures will make the Volunteer and his/her university or the vendor representative and his/her company subject to disciplinary actions up to and including immediate removal from Beacon Health System and subsidiaries and prohibition from future contact at Beacon Health System and subsidiaries.

The essence of these policies and procedures are restated in the following guidelines for the use and disclosure of medical, staff member, proprietary and other information of Beacon Health System and subsidiaries.

1. Original records should not be removed from their location except as ordered by appropriate personnel or legal authorities.

2. Volunteers or vendor representatives granted record access are accountable for the protection of the record and its contents while it is in his/her possession and will not allow the record or the information in the record to be used or disclosed to third-parties without the expressed approval of Beacon Health System and subsidiaries.

3. Volunteers or vendor representatives will not at any time during or after his/her affiliation with Beacon Health System and subsidiaries disclose medical, staff, proprietary or other information of Beacon Health System and subsidiaries.

4. Volunteers or vendor representatives granted access to computer systems at Beacon Health System and subsidiaries will not at any time attempt to access his/her own medical information, medical, staff, proprietary or other information for which they do not have a legitimate reason to do so and will secure access to the computer when it is not in use. This information includes, but is not limited to, the medical, staff, proprietary and other information of family, friends, business associates, patients and staff members.

5. Volunteers or vendor representatives granted access to medical, staff, proprietary or other information shall follow all Beacon Health System and subsidiaries policies and procedures on the handling, storage and disposal of medical, staff, proprietary or other information.

6. Volunteers or vendor representatives granted access to computer systems at Beacon Health System and subsidiaries will not share or disclose their computer sign on nor attempt to learn another person's computer sign on. If the Volunteer or vendor representative believes his/her computer sign on has been learned by another person, the Volunteer or vendor representative will contact the Security Administrator or a Management person immediately.

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Social Media Policy

Social Media Policy

When using social media:

  • Be clear that your posts reflect your personal opinion and not those of Beacon Health System.
  • Know that "friending" patients on social media is discouraged.
  • Know that only the Beacon Marketing and Corporate Communications departments can create Beacon-branded social media pages, websites, blogs, etc.
  • Never post pictures of patients.
  • Never disclose confidential information about patients and clients, business arrangements and strategic business plans or other proprietary information.
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Parental Permission
I give permission for my child to participate in the Volunteer program offered by Beacon Health System. I agree that my child will abide by Beacon Health System's Volunteer Standards and Performance Essentials to remain active as a volunteer and that failure to do so may result in immediate dismissal from the program.
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Parents Contact Information: