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Confidential
The purpose of the health declaration is to see if you have any health problems that could affect your ability to safely and effectively undertake the duties of the volunteer role you are conducting.
If you answer “no” to this question no further action will be taken and this declaration will remain on your personal file to confirm that you do not have any relevant health problems on commencement of your volunteer role.
If you answer “yes” to this question further discussion will be necessary to find out more information regarding the nature of your health condition and whether or not it might affect your volunteer role. All efforts will be made by the hospice to fairly and openly assess the impact your declared health condition might have upon both your performance of your volunteer role and the service that we provide to our patients and their families and carers. Advice and guidance may be sought from the hospice occupational health service or from your General Practitioner (with your prior permission). All information provided will be treated in the strictest confidence.
Completion of the form is mandatory and is a requirement of the hospice’s registration with the Care Quality Commission. If you choose not to complete the form the Hospice will not be able to process your application to become a volunteer in the role specified above but we may be able to offer you a different volunteer role subject to such a role being available.
Because of the nature of the work undertaken by St Elizabeth Hospice, we require you to answer the following questions. In the event of on boarding, any failure to disclose such convictions could result disciplinary action or dismissal by the Hospice. Any information given will be completely confidential.
Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975
Have you ever been disqualified from the practice of a profession or required to practise under specific limitations?
Are you the subject of any current investigation or proceedings by a professional or regulatory body in the UK or any other country?
Data Protection Act 1998 and General Data Protection Regulations 2018
This form has been designed to provide us with sufficient basic information to add you to our supporter database. The information you supply in this form is confidential and will only be used by those involved in the appointment in line with the Data Protection Act 1998 and the General Data Protection Regulations 2018. For further information please refer to the GDPR information within the hospice’s privacy notice which can be found on the website.
As a volunteer for St Elizabeth Hospice we will send you newsletters and information.
Please tick the boxes below, so that we can continue to share information and ask for your help.
We will never pass on your personal information to third parties. You will automatically receive communication from us relating to your volunteering activities; in addition, we would like to contact you to inform you about other ways to support the hospice.
Wherever possible we will send communications electronically as this helps to save money on printing and postage costs.
From time to time we may need to check with you to make sure you are still happy to be contacted in the same way you have chosen.
If you decide to leave the hospice, we will ask you if you are still happy for us to contact you via the communication methods you have chosen above.
I hereby sign to the best of my knowledge that the above information is correct, and I understand that as a volunteer my details will be held on a secure database for the hospice use only.