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Volunteer Covid-19 Return Plan 

*Once 55% of population 16 and older are vaccinated we can start bringing volunteers back

*If volunteer is sick or has symptoms, they should not come in and stay home until a negative  test result or 7 days symptom free  

*Employers may allow fully vaccinated volunteers to not wear face coverings and social distance  provided they have a policy deemed effective to ensure non-vaccinated individuals continue to follow  these requirements 

*Volunteer must have a copy of their vaccination card on file  

*At the beginning of the day volunteers must sign Covid-19 return plan. 

*Volunteers will understand and follow all Safety Protocol ** 

*Volunteers will follow all hand washing and basic hygiene protocol; hand sanitizer and sani wipes will be available on all sites 

*Volunteers will wear a mask when in shared workspace 

*Social distancing protocol will be in place in break rooms and during organized lunch hours,  

*lunch hours will be staggered to meet social distancing requirements 

*Volunteers will be responsible for wiping down personal workspace throughout the day,  common areas will be cleaned on a daily basis

*Increased monitoring of the site and volunteers, including but not limited to, performing  temperature checks of your workforce, maintaining logs of tasks performed and increased safety  documentation. Upon arrival volunteer will undergo safety protocol survey and get temperature  checked before the start of the work day 

*If an individual onsite is exhibiting symptoms, send the individual home to self quarantine or seek medical care as necessary.

**Safety Protocol 

• Frequent and thorough hand washing, including by providing workers, customers, and worksite visitors with a place to wash their hands. If soap and running water are not  immediately available, we will provide sani-wipes. 

• Please stay home if you are sick.  

• Please cover all coughs and sneezes using a tissue and dispose properly in a trash  receptacle. 

• Clients will not be permitted in any workspace if they have had any symptoms in the last  14 days or not wearing a mask., homeowners may work on-site as volunteers following  all volunteer safety requirements. 

 

I, understand the new safety protocols and will abide by the restrictions set forth by the CDC.  

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

* All volunteers should be screened in advance. Confirm that all project partners have a safety  plan in place and are following it. If the visitor can answer "yes" to any of the following questions (without identifying which question applies), the visitor will not be permitted to access the site.

1. Have you been asked to self-quarantine in the last 14 days?*
No
Yes
2. Have you been in close contact with any person(s) who has been asked to self quarantine in the last 14 days?*
No
Yes
If you answered yes to question 1 or 2 have you been cleared by physician?*
No
Yes
3. Have you experienced a recent onset of any illness-related symptoms, such as fever, cough, or shortness of breath?*
No
Yes
4. Have you been in close contact with any person(s) who has been diagnosed with COVID-19?*
No
Yes
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

* All volunteers should be screened in advance. Confirm that all project partners have a safety  plan in place and are following it. If the visitor can answer "yes" to any of the following questions (without identifying which question applies), the visitor will not be permitted to access the site.

1. Have you been asked to self-quarantine in the last 14 days?*
No
Yes
2. Have you been in close contact with any person(s) who has been asked to self quarantine in the last 14 days?*
No
Yes
If you answered yes to question 1 or 2 have you been cleared by physician?*
No
Yes
3. Have you experienced a recent onset of any illness-related symptoms, such as fever, cough, or shortness of breath?*
No
Yes
4. Have you been in close contact with any person(s) who has been diagnosed with COVID-19?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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