RNLI LIFEGUARD VOLUNTEER ENROLMENT FORM Thank you for your interest in RNLI Lifeguards. The RNLI is the leading provider of Beach Lifeguard services across the country, and relies heavily on voluntary contributions as well as a great deal of volunteer expertise in the provision of its life saving services. Volunteer lifeguarding is a rewarding way of supporting full-time Lifeguards, developing your skills and competencies, and fitting in patrolling when you are available to help. RNLI Volunteer Lifeguards enjoy the same standards of support, training, education and equipment that comes with being part of the RNLI, and ultimately contribute to saving more lives at sea. To become an RNLI Lifeguard, you will need to meet the following minimum requirements: 1. Hold a valid and recognised Beach Lifeguard Qualification 2. Be compliant with the RNLI’s medical requirements (available on request) 3. Complete a surf competency and fitness test, the requirements of which can be obtained on request or from the RNLI website (www.rnli.org.uk/lifeguards) 4. Be at least 16 years of age. Any applicants aged under 18 years of age must complete a parental consent form (section 7) It is recommended that you are a member of a Life Saving Club affiliated to either SLS GB or RLSS UK. Please note that your application process will be looked after by an RNLI Volunteer Development Officer, however your suitability and subsequent rostering and deployment as a Volunteer Lifeguard is at the discretion of the RNLI Area Lifeguard Manager Area applied for / Club name Section 1: Personal Details Surname: Title: Forename(s): Gender: Known As (no nicknames): Date of Birth: Age: Address: Post Code: Home Tel Number: Mobile Number: Email: Occupation: Section 2: Emergency Contact Details Name: Relationship: Address: Post Code: Home Number: Mobile Number: Section 3: Lifeguard Qualification The RNLI will ensure that all necessary training over and above the Beach Lifeguard Award will be provided. To become a Volunteer Lifeguard you will require a valid Beach Lifeguard Qualification, which will be in date until the end of the season. Please provide photocopies of your qualification certificates and return along with this form, or ensure that an RNLI Volunteer Development Officer has seen your original certificates and signed this form before it is submitted. It is essential that you complete the expiry date column. Award/Governing Body Qualification (Date taken, where gained) Expiry Date Section 4: Lifeguard Experience Please enter details of any beach lifeguard or related experience below: Section 5: Availability The RNLI will look to the club to co-ordinate availability for patrols, however the Area Lifeguard Manager will require notification in time to prepare a duty roster for the beach/area on a weekly basis. Therefore some indication as to availability would be useful. Date available from: Please indicate your availability below: Mon Tues Weds Thurs Fri Sat Sun Section 6: Driving Licence For some volunteer lifeguard positions a driving licence may be required. Do you hold a valid UK driving licence? YES NO Section 7: Parental Consent All applicants aged under 18 require parental consent, the following declaration must be completed and signed by both parents or guardians: We hereby give consent for our son daughter ward (please tick as appropriate) Name Date of Birth / / to become a volunteer RNLI Lifeguard. We understand that this may involve him or her in arduous activities in potentially hazardous conditions. Signed Mother/Guardian Date: / / Signed Father/Guardian Date: / / (Due to the nature of this role and in accordance with the Children’s Act 1989, it is important that two signatures are provided; if this is not possible please inform your ALGM / ALGS) Section 8: Please ensure you read the following sections carefully and complete accompanying paperwork where necessary. Data Protection We take our responsibilities under data protection seriously. These require us to explain how the data you have provided on this form and other personal data that may be created in connection with your enrolment may be used. Any data provided by you, or by any third parties such as a club officer, will be used in connection with your enrolment only. Access to this data will be restricted to those responsible for recruitment. Personal data relating to your enrolment will be held securely for a period of six months from the date of receipt of your form. Following this period it will be destroyed. If you are successfully appointed, relevant information may be taken from this form and used as part of your record. Disclosure of Criminal Records Due to the nature of work undertaken by a volunteer RNLI Beach lifeguard this post is exempt from the Rehabilitation of Offenders Act 1974. If your enrolment is successful you will need to complete a Disclosure form from the Criminal Records Bureau (CRB) for England and Wales or their counterparts in Scotland and Northern Ireland. We will only consider criminal records that affect the nature of the job applied for. Details of our recruitment policy of ex-offenders are available from the HR department. Medical Requirements As a part of the enrolment process, you will need to complete the enclosed confidential medical questionnaire. Please ensure all questions are answered and to ensure confidentiality return to our Consultant Occupational Heath Physician in the envelope provided. Section 9: Declaration (To be signed in all cases by applicant) I certify that, to the best of my knowledge, the information I have given is accurate and that I am in good health and fit to carry out the duties of the role for which I am applying I have informed my employer that I will be volunteering for this role. I will undertake medical and eyesight examinations as required by the RNLI and agree to follow the relevant guidance and policies applicable to this volunteer role. I fully understand that this is a volunteer role and I am not an employee. I am reliable and trustworthy and will help to maintain and preserve the reputation of the RNLI. I am aware of the Volunteer Commitment, the Code of Conduct and the volunteer policies which have been explained to me and to which I commit and agree to. Signed: Date: / / Section 10: Club Officer Recommendation (to be completed by authorised club committee member) Applicant known to Club: YES NO Applicant recommended: YES NO Signed: Date / / Position in club: RNLI USE ONLY – AREA LIFEGUARD MANAGERS / SUPERVISORS / VOLUNTEER DEVELOPMENT OFFICERS TO COMPLETE BEFORE SENDING TO HR Please note that it is an RNLI requirement that this fitness level is maintained throughout the season if you are to remain an active volunteer. Your RNLI Volunteer Development Officer will oversee and guide you through the fitness testing, to fit in as far as possible with your availability (for example within a club training session etc). Pool Swim Times Beach Run Times 200m mins 200m secs 400m mins 25m underwater & 25m surface swim (consecutively) secs Signed: Date: Title: Medical Questionnaire For RNLI Volunteer Lifeguards Guidance Notes This Medical questionnaire should be completed by applicants who have not worked for the RNLI before, have not worked for the RNLI in the previous season, or have answered YES to a question in the Medical declaration for returning lifeguards. The RNLI has a duty to the public, its volunteers and its employees to ensure that its Lifeguards are fit for purpose. The Lifeguards website contains a Medical Standards section which we advise you to read prior to completing this questionnaire. If you do not have Internet access, a hard copy can be obtained by contacting the RNLI’s HR Dept on 01202 663362. TO BE COMPLETED BY APPLICANT – PLEASE ANSWER ALL QUESTIONS IN BLOCK CAPITALS SURNAME: FORENAME: POST APPLIED FOR: VOLUNTEER LENGTH OF SEASON: N/A FULL-TIME N/A CASUAL N/A Please list the jobs you have held in the past 5 years and give approximate dates (continue on a separate sheet if necessary) From To Has your employment ever been terminated on the grounds of ill-health YES NO Approximately how many days / weeks sickness did you have: Last 12 12 months Months prior to that What is your height: What is your weight: Are you currently receiving any form of medical supervision or taking prescribed medication: (e.g. attending an osteopath, physiotherapy, hospital YES NO outpatients, taking regular medication? When did you last see your GP and why? Please send completed form, ensuring it is marked confidential, to the following address: For the Attention of the Consultant Occupational Physician c/o HR Department Royal National Lifeboat Institution West Quay Road Poole, BH15 1HZ Pre-Employment Medical Questionnaire for New RNLI Lifeguards – Page 2 Are you currently from or have you ever suffered from any of the illnesses listed below? (Please circle your answer) 1. Heart trouble YES NO 2. High Blood Pressure YES NO 3. Lung disease (e.g. Bronchitis, TB) YES NO 4. Stomach / Bowel Trouble YES NO 5. Hernia or rupture YES NO 6. Kidney or bladder disorders YES NO 7. Jaundice / Hepatitis YES NO 8. ME / Post Viral fatigue syndrome YES NO 9. Joint problems YES NO 10. Back / neck problems YES NO 11. Diabetes YES NO 12. Any allergies (e.g. Hay fever, Eczema etc.) YES NO 13. Asthma YES NO 14. Skin problems YES NO 15. Frequent / severe headaches or migraine YES NO 16. Severe stress reaction YES NO 17. Depression / anxiety / other mental health problems YES NO 18. Fits / faints / blackouts / epilepsy YES NO 19. Serious accident YES NO 20. Surgical operations YES NO 21. Eye or sight problems YES NO 22. Hearing or ear problems YES NO Please comment if the answer to any of the above questions is “Yes” Pre-Employment Medical Questionnaire for New RNLI Lifeguards - Page 3 PLEASE ANSWER THE SECTION ON EYESIGHT IN FULL The RNLI’s recommended eyesight standard for Lifeguards is currently 6/18, 6/18 unaided, correcting to 6/9, 6/9 using glasses or contact lenses. Would you have a problem meeting this standard? YES NO Do you currently wear: Glasses? YES NO Contact Lenses? YES NO Have you ever had laser or other eye surgery? YES NO If the answer to any of the above is “YES”, you may be asked to attend an Optician for an eye test, at the RNLI’s expense. DECLARATION (To be signed by all applicants) • I understand that the RNLI requires information about the health of lifeguards to ensure their health, safety and welfare. • The information I have provided is accurate and I have not withheld any details. I understand that if, at a later date, it is discovered that I have knowingly withheld medical information, the RNLI may take disciplinary action against me, which may include immediate dismissal. • I consent to these data being processed and held by the RNLI Consultant Occupational Physician on a computer or manual filing system in accordance with the confidentiality requirements of the Data Protection Act 1998 (Data Protection Act 1988 in the Republic of Ireland). Signed: Date: FOR USE BY THE CONSULTANT OCCUPATIONAL PHYSICIAN If ‘no’, reason for decision FIT TO ACCEPT YES / NO SUBJECT TO REVIEW YES / NO Date of Review Date Signed GP CONSENT FORM TO BE PRINTED AND COMPLETED BY ALL APPLICANTS Surname: Address: Forenames: Date of Birth: Tel no. (inc. Code) Post/Area Code General GP Address Practitioner: In order to clarify the information that you have given in the medical questionnaire overleaf it MAY be necessary for the RNLI Occupational Health Physician to apply to your doctor for a report. The content of any such report is confidential and made known only to the Occupational Health Physician. This consent relates only to a request to your doctor as part of the appointment process and will not be used later in any other context. Your rights under the Access to Medical Reports Act 1988 are summarised below. This Act applies in England, Wales and Scotland. There is similar legislation in place in Northern Ireland under the Access to Personal Files and Medical Reports (NI) Order 1991 and in the Isle of Man under the Access to Health Records and Reports Act 1993. Please read these rights carefully before you sign this form. You are entitled to: 1. Withhold your consent to the RNLI making an application for a copy of your medical report to your doctor. 2. Give your consent to the RNLI applying for a copy of your medical records but subject to you seeing a copy of your medical report before it is supplied to the RNLI’s Occupational Health Physician. You have 21 days from the date the report is requested, to view it before it is sent. If your doctor has not heard from you in writing within 21 days from the date of the report, then he or she will assume that you do not wish to see the report and that you consent to it being supplied. It is your responsibility to make the necessary arrangements with your doctor. 3. When you see your report, if there is anything in it that you consider to be incorrect or misleading, you can make a written request to your doctor asking them to amend the report. If your doctor declines to amend the report, then you have the following options: a. To withdraw your consent for the report to be issued b. You can prepare a written statement setting out your views and ask your doctor to attach this statement to your report c. Agree to the report being issued unchanged. Note that your doctor is not obliged to show you any parts of the report that he or she believes: i. Might cause serious harm to your physical or mental health or to that of others or; ii. Which would reveal information about a third party or would identify a third party who has supplied the doctor with information about your health unless that third party also gives consent. In the event of this happening your doctor will advise you of this and your access to the report will be limited accordingly. 4. You may give your consent to the RNLI receiving a copy of your report indicating that you do not wish to see the report before it is supplied. In the event that you change your mind after the application is made and you notify your doctor in writing, he or she should allow 21 days after receiving that notice for you to have access to the report (provided the report has not already been supplied before you change your mind). You are entitled to have access to your medical report at any time up to six months after the report has been supplied. It is your responsibility to make the necessary arrangements with your doctor. Please also note that where a copy of the medical report is supplied to you, your doctor may charge a reasonable fee to cover the cost of supplying it. Declaration I understand why the RNLI is collecting this information and confirm that I have been informed of and understand my statutory rights under the Access to Medical Reports Act 1988. I hereby give my consent for the RNLI’s Occupational Health Physician to apply for a medical report from my doctor. I understand that this consent form will be copied to that doctor and shall have the validity of the original. I *do / do not (*delete whichever not applicable) wish to see my doctor’s medical report before it is sent to the RNLI’s Occupational Health Physician. Signed: Dated: Please return to the RNLI at the above address.