Role Description - HH Staff Only

HH Staff Only - Role Description Form
Today's date
Contact First name
Contact Last Name
Contact = the employee who will supervise the volunteer
Step 1
Is this a research Role?
If "NO" skip to Step 2
If "yes" what is the level of CITI training required?
Group 1: Biomedical Research Investigators and Study Personnel
Group 2: Social & Behavioral Research Investigators and Study Personnel
Group 3: Students conducting no more that minimal risk research
Group 4: IRB members
Group 5: Human Research Protections Program Staff
Group 6: Research with Data or Laboratory Specimens ONLY (no direct patient contact)
Full IRB Study Title
IRB Study Number
Name of Study PI
Step 2
Title of Volunteer Position
Location of role ie. B5E, CB2, Brownstone Bld etc.
Why is this role being created?
How will this role support your department?
How will you measure the impact of this role?
Volunteer Qualifications/Skills Desired:
Physical Requirements:
Role Description/Specific Duties: (PLEASE remember that any function not written in this role will not be covered by the hospitals liability policy if it is performed.)
Volunteers needed beginning:
Please list days and times needed
Will you accept teens for this assignment?
If yes, please check age range you feel would be appropriate:
16-18 years
14-18 years
Will this person have any physical contact (three feet or less) with patients?
Will this person have any access to patient medical records?
Will this person be involved in any patient care or treatment decisions?
Training you will provide (ALWAYS includes age-specific competencies):
I understand it is the responsibility of my department to provide training on age specific competencies, diversity, department specific infection control and safety policies/procedures.
If Novell access is required, the department of Volunteer Services will provide you will an identification number
after the volunteer has been placed in your Department.
Each receiving Department is responsible to request access for their volunteer.