Thank you for your interest in volunteering at Chesapeake Regional Healthcare! Please complete the following application.
First Name *

Last Name *

Best Daytime Phone Number *

1. CONFIDENTIAL INFORMATION Information you see or hear about patients and employees is confidential and is not to be repeated.

COMPUTER USE Some volunteer positions require use of a hospital computer.  If your job requires access to a hospital PC (Personal computer) you will be given a sign-on through the volunteer office.  Hospital computers are not for personal use – please do not use the computer for personal e-mails or to look up sites for your own interests.  Our Information Technology department monitors all computers on the hospital network for misuse. 

General Information
: Please do not wear denim materials, T-shirts, sleeveless blouses or shirts, stretchy materials, sweat    pants, sweat shirts, leggings, shorts, flip flops or sandals in patient areas.  Not Allowed-visible body piercings.
Women Several uniform styles are available in the volunteer office at a wholesale price and are to be worn with a coordinating shirt or blouse & khaki pants or khaki skirt.  Black or white pants are acceptable as well. Tennis shoes or walking shoes are acceptable. Navy blue golf shirts are also available to wear.   Please do not wear perfumes or excessive jewelry.   
Men A navy blue golf shirt with khaki pants and comfortable walking shoes is appropriate. Please do not wear colognes or excessive jewelry.
Student Volunteers A red golf shirt with khaki pants and comfortable tennis shoes is appropriate.  Red golf shirts are available in the volunteer office at wholesale cost.  Capris are acceptable.
Please do not wear jeans, T‑shirts, miniskirts, short shorts, leggings, sleeveless blouses, sweatpants, or sweatshirts.  Please do not wear perfumes, colognes, excessive jewelry, heavy make‑up or unusual nail polish. 
Not Allowed:  unnatural hair colors (shocking tones) or visible body piercings

 NAME TAGS A permanent nametag will be made for you. Please wear your nametag on your uniform at all times, on your shirt collar for visibility.  You can not volunteer without a nametag.

4. ILLNESSES Please stay home when you are not well. Quite often, you will become more ill or possibly spread your illness to others.

5. ACCIDENTS/INJURIES If you are injured at the hospital while on duty, please report the accident or injury to your immediate supervisor and the director of volunteer services.  You will be referred to the occupational health nurse for assessment and treatment if needed.

6. ABSENCES There is a sign out calendar in the Volunteer Services office for volunteers assigned to the Information Desk and Messenger Service.  The Gift Shop has a sign out calendar in the office area.  Please sign out on the calendar as far in advance as possible. The Volunteer Services Office will schedule a substitute to cover your shift.  If you become ill or cannot keep your scheduled shift, please notify the volunteer services department immediately at (757) 312‑6109 so that a substitute can be scheduled.

7. TELEPHONE CALLS/IPODS Local telephone calls can be made from the telephone that is located in the back room of the volunteer services department.  Dial 9 for access to the outside line. The use of cell phones is permitted only while you are on a break. DO NOT use a cell phone or text while on duty.  No IPODS/headphones allowed.   When you answer the telephone at your volunteer station, always give your name and identify yourself as a volunteer.

8. PPD TESTS All adult volunteers receive a two-step baseline tuberculosis screening upon acceptance to the volunteer program.  Yearly, volunteers have an updated test.  High School Students – Please submit your TB results from your primary care physician.

9. CAFETERIA While on duty, volunteers receive a 20% discount in the hospital cafeteria. Volunteers are encouraged to eat in the cafeteria.  Food that is taken out of the cafeteria needs to be properly covered with styrofoam to prevent spilling.  Please eat in a lounge area and not at your volunteer station.

10. PATIENT ROOMS Always check for an isolation sign. Knock before entering a patient's room.  Do not enter an Isolation Room.

Always check with your immediate supervisor when you need a break.  You may take a 15-minute break for each 4-hour shift that you work.  If you work more than four and one half-hours, please feel free to take a 30-minute break for a meal.

12. VALUABLES It is not recommended that you bring your purse into the hospital.  However, you can usually place your purse in a designated area in your department.  Do not bring large amounts of cash or other valuables to the hospital.  Coats can be hung in the volunteer services department.  Do not bring an ipod for use at a work station.

13. VISITING  You are welcome to visit patients before or after your shift.  Please stay at your station while on duty at the hospital.

14. SOLICITING Personnel policy does not permit soliciting by volunteers or employees within the hospital. Examples:  selling raffle tickets, social function tickets, cosmetics, jewelry or household products.

15. FLU SHOTS Volunteers are eligible to receive a flu shot at no cost.  Flu shots are mandatory for all volunteers and employees.  The shots are usually given in October or November of each year.

16. SIGN‑IN/SIGN‑OUT Please sign in and out on the Computer located in the volunteer office – you will use your phone number (without area code) as your pin number. Sign in sheets are available in our off-site locations as well as some computer locations.

17. ORIENTATIONS/IN‑SERVICES Volunteers are required to attend a general orientation upon acceptance to the program.  All volunteers are required to attend a re-orientation or review and sign off on a policy manual yearly.  

18. SUGGESTIONS/CONCERNS If you have new ideas or concerns about your volunteer assignment, please contact Nancy Elliott, Director of Volunteer Services, 312‑6109.  We welcome innovation and appreciate your interest.

19. RECRUITMENT Please encourage your friends to volunteer at Chesapeake Regional Medical Center.     Applications are available at Prospective volunteers need to schedule   an interview appointment with the Director of Volunteer Services.

20. PARKING All parking is available in the Volunteer Lots near the front of the Cancer Treatment Center at the    north end of the hospital.     Overflow parking is available for volunteers behind the Lifestyle Center.    A parking decal is to be placed on the right rear window or bumper of your car. If you experience car problems while on hospital grounds, the Security personnel at the hospital will help you. The security staff can be contacted by either the volunteer office, information desk volunteers, or by calling the hospital operators.

21. SMOKING CRH is a smoke free work place. Smoking is not allowed anywhere on campus.

22. PERFUME/COLOGNES The use of perfumes, colognes, and scented lotions by employees and volunteers is not allowed.

Rev. 5/17

Please check YES if you agree to the above guidelines:
Please enter your full name to confirm you've read the Volunteer Guidelines *

Please read the following Volunteer Confidentiality Agreement and check YES if you agree to the Confidentiality Agreement.

Confidentiality Agreement
Chesapeake Regional Medical Center recognizes the importance of protection of confidential information concerning patients, their families, medical staff members, coworkers, and the operations of the hospital. Treating confidential information in an appropriate manner is a requirement to ensure the trust of our customers and patients and to maintain respect for all persons. It is the obligation of every employee, student, volunteer, medical and professional staff member, and contractor to maintain this confidentiality. Each employee’s position and/or job responsibilities, as well as CRMC’s computer systems, allow access to restricted or confidential patient, employee, and hospital information. As such, it is extremely important that each associate verify the preceding and agree to the following:
- I understand and agree that I have the responsibility for maintaining strict confidentiality of information shared with me or acquired by me as part of my duties. Any patient information; confidential information about a fellow employee, his or her family, or physician; or management and financial information regarding the facility that is made available to me is for my professional use only. I understand that such information may be discussed only as needed to properly perform the duties of my position. I further understand that this prohibition extends to any disclosure to colleagues, other staff, family, or any other individual not involved in the scope and performance of my duties.
- I will protect the confidentiality of patient, staff, and hospital information and will not disclose or release restricted or confidential information to any third party within or outside the hospital except to the extent required by my normal job duties. I further understand that this information will be used only in the performance of my necessary duties. I will not discuss information about a customer or patients outside of the facility, in public areas of the facility, or any place where I may be overheard.
- I will not access or attempt to access information other than that information which I have been authorized to access and have a need to know in order to perform my job.
- In regards to computerized information/access, I also agree that: The computer user ID, in combination with the password I create, is unique to me. I acknowledge that my user ID and password are to be maintained as confidential and are for my use exclusively. All system accesses and entries that I make will reference my identity with this user ID and password, and I understand that I am responsible for any and all activity performed using my user ID and password.I understand that if I disregard the confidentiality of my passwords, willingly inform another person of my password, or use the user ID and password of another person, I will be subject to disciplinary action, up to and including termination.If at any time I feel my password security has been violated, I will immediately contact CRMC’s help desk, or Security Officer.I acknowledge that using CRMC's computer systems will subject me to having my activities routinely monitored by system and security personnel. I expressly consent to such monitoring and am advised that if such monitoring reveals unprofessional or possibly criminal activity, system or security personnel may provide the evidence to appropriate management or law enforcement officials.
- I understand that there are various security codes and passwords belonging to CRMC’s physical premises or equipment that I may be given in the course and scope of my duties. I understand that these codes and passwords are confidential and subject to the provisions of this agreement.
- I understand that unauthorized or indiscriminate disclosure of such confidential information or any violation of this agreement may subject me to corrective action up to and including termination of employment and suspension or loss of privileges. *

I have read, understand, and agree to adhere to the conditions of this confidentiality agreement.
Please enter your full name to confirm you've read the Confidentiality Agreement. *

Please enter your full name to acknowledge that you have received information on Chesapeake Regional Medical Center’s mission, vision and values, and that you pledge to demonstrate the aforementioned behaviors that support CRMC’s commitment to each other and those in our community. *


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