VOLUNTEER

Name *

First Name

Last Name

Have you been diagnosed with COVID-19 or have symptoms? *

Yes

No

Have you, or anyone you have been in contact with, been overseas in the past two weeks or been in contact with someone who has potentially been exposed to COVID-19? *

Government requires people who have returned from overseas, or who may have been exposed to COVID-19, in the past two weeks to self isolate for 14 days. We will not be able to accept any volunteers who fall into this category

Yes

No

Do you fall in to one of the high risk categories as described below? *

People over 70 years of age, people who have compromised immunity or people who have underlying respiratory conditions. Government is asking anyone in this category to stay at home as much as they can - however you will still be able to participate in our caring caller service if you would like to volunteer.

Yes

No

What can you help with *

Can you help with Telephone support for our community?

Caring Caller - telephone support for those isolated from your own home (using your own phone)

Do you consent to a Police Vetting Check *

Forms will be supplied by Community Link, 2 forms of idetification will be supplied

Yes

No

Declaration *

Some members of our community are more vulnerable to COVID-19. At risk people include: Those over 70: Older people often have underlying health issues, including respiratory issues that make them more vulnerable to COVID-19. People with medical conditions: Underlying medical conditions can make you more vulnerable to COVID-19. In particular, people with respiratory conditions, such as COPD (Chronic Obstructive Pulmonary Disease), heart conditions, high blood pressure, kidney problems and diabetes. People undergoing a treatment for cancer and blood conditions: As treatments for cancer and blood conditions affect people’s immune systems, this makes them more vulnerable to COVID-19. Pregnant women: Health experts do not yet know if pregnant women are impacted by COVID-19 in the same way as other people. However, pregnant women experience changes in their bodies that may increase their risk from some infections. People without easy access to healthcare We cannot have anyone who fits this definition undertaking Volunteer work during the COVID-19 pandemic (with exception for the Caring Caller telephone service)

I confirm that I I am not a vulnerable person as defined by the Ministry of Health:

I am a vulnerable person as defined by Ministry of Health and can only be available as a caring caller volunteer.