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					               NMDOH POD Administrative Toolkit – Volunteer Orientation Checklist                   Page 1 of 2

                          POD VOLUNTEER ORIENTATION CHECKLIST

  To be completed by the supervisor prior to the volunteer starting work with in a NMDOH
  POD.

  Volunteer Name:

  Start Date:                                          Date of Orientation Initiation:

  □ Clinical Staff (e.g., nurse, EMT)
  □ Non-Clinical (e.g., security, data entry, education)

                                                Task                                             Date completed or
                                                                                                        N/A
Assignment of a coordinator/supervisor:


Registration in NMserves (http://www.nmserves.org/)
  Facilitates professional license verification/credentialing and background/reference
  checks, and addresses volunteer liability coverage
Copy of Driver’s License
Copy of professional license and/or certification, if applicable
Completed POD Volunteer Information Summary Form
Completed NMDOH Volunteer Application
Completed NMDOH Volunteer Agreement
HIPAA Volunteer Training Information
Safety Information
*Signed copies of policies marked with asterisk should be provided to the volunteer.

                                   Other training specified by supervisor (list below)




  Equipment Provided:
          Type                                Condition                                    Date Provided




  By signing this form the volunteer agrees to have a security background check
  performed.

  Volunteer signature:                                                             Date:

  Supervisor signature:                                                            Date:




  Document # POD Administrative Toolkit 3.5       Document release 20100427                           Page 1 of 2
             NMDOH POD Administrative Toolkit – Volunteer Orientation Checklist                Page 2 of 2


                                            Upon End of Service

Date             Task                                          Initials of staff completing this task

                 Return of NMDOH Equipment                              YES/NO


                 Exit interview                                         YES/NO

We will use your comments, criticisms and suggestions to improve our volunteer deployment
procedures.

List your role(s) during the deployment (example: usher, medication dispenser, registration clerk).
__________________________________________________________________________________________

Your experience during the 2009-2010 H1N1 Influenza Vaccine Administration Campaign:

Please comment on the volunteer check-in process, providing suggestions for possible improvement if
you have them.
__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Were you provided adequate training to perform your responsibilities on deployment? If no, what aspect
of the training was inadequate or missing?


__________________________________________________________________________________________

__________________________________________________________________________________________

What could have been done differently to make this response/deployment a better experience for you as a
volunteer?
__________________________________________________________________________________________

__________________________________________________________________________________________




Volunteer signature:                                                         Date:


Supervisor signature:                                                        Date:




Document # POD Administrative Toolkit 3.5   Document release 20100427                            Page 2 of 2

				
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