Ovingdean Action Volunteer Form

Covid-19 Neighbour Support Scheme

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* 1. Contact details

Name

Age (18-69 only please)

Address (Ovingdean Residents Only Please)

Post Code

Landline Number

Mobile Number

Best method of contact (please state)

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* 2. Do you live in Ovingdean?

Yes, I live in Ovingdean

No (Thank you for offering help, we are only accepting Ovingdean residents)

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* 3. What can you help with?

Essential shopping (physically going to the shops and dropping off)

Running other errands (e.g. pharmacy, other essentials)

Pet care, including dog walking

Telephone contact (keeping in touch with people who are unwell or in isolation)

Telephone logistics (helping someone to manage or solve issues as they arise)

Childcare for Key Workers (e.g. NHS workers)

Online / computer support (e.g. ordering shopping, assisting people to set up technology to reduce isolation)

Other skills / experience (please specify)

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* 4. Do you use WhatsApp?
WhatsApp could be used as a way to communicate with volunteers as requests come up as it is quick and easy to use (WhatsApp is an App used on Smart phones, a bit like a group text).

Yes, I have it and am prepared to use it

No, I don't have it but am prepared to download it on a smart phone

No, I don't have it and cannot access it

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* 5. Do you have any concerns you might have for yourself that you would like us to be aware of? (You don't have to answer this but it helps us to identify if you might need additional support). Tick any or all that apply:

I am over 70

I live alone

I have an underlying health condition

I do not have family or friends that live nearby

The majority of my friends or family are over 70 or have underlying health conditions

I have moved to the area recently and don't know many people yet

Other (please specify)

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* 6. When, generally, could you volunteer? Please tick any that apply.

	Morning	Afternoon	Evening
Monday	Monday Morning	Monday Afternoon	Monday Evening
Tuesday	Tuesday Morning	Tuesday Afternoon	Tuesday Evening
Wednesday	Wednesday Morning	Wednesday Afternoon	Wednesday Evening
Thursday	Thursday Morning	Thursday Afternoon	Thursday Evening
Friday	Friday Morning	Friday Afternoon	Friday Evening
Saturday	Saturday Morning	Saturday Afternoon	Saturday Evening
Sunday	Sunday Morning	Sunday Afternoon	Sunday Evening

Other (please specify)

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* 7. I have some specific concerns or questions (please state here):

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* 8. ALL VOLUNTEERS MUST READ AND TICK BOX:
I understand that I am giving my time to support Ovingdean residents in an informal capacity during this specific time of need during the Covid-19 outbreak.

This includes:

1) Agreeing NOT to give health-related advice, except to signpost people to credible sources which include:
- Public Health England: https://www.gov.uk/government/organisations/public-health-england
- World Health Organisation: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
- National Health Service: https://www.nhs.uk/using-the-nhs/nhs-services/urgent-and-emergency-care/nhs-111/

2) Not using or saving any personal information or data relating to your task. This means NOT disclosing anyone's C-19 status, address or contact details with anyone without explicit consent of the individual.

3) Letting co-ordinators know immediately if you cannot fulfil on a request that you have accepted.

4) Voicing any concerns you have to the co-ordinator.

5) Consenting for your contact details and information provided on this form to be stored electronically by the Ovingdean Action C-19 Group for the specific purposes of managing our response to this C-19 pandemic.

6) Understanding that your contact details will be given to people in need after taking on a specific request.

7) Agreeing not to take cash or to use your own personal money to buy items for people but to use the system put in place.

Yes, I agree to all points above

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* 9. Thank you so much for being the generous person you are; going over and above to support your local neighbours and friends. Please remember to take care of yourself, and to ensure that you only take on tasks if you feel well and have the capacity to do so. It's OK to say no at any time, and we will assume you are following all government advice, taking care of yourself, having your own support structures in place, and will ask if there is anything you need or want to know or ask.

Do you have any additional comments or ideas you'd like to share?

Ovingdean Action Volunteer Form

Covid-19 Neighbour Support Scheme

Question Title

* 1. Contact details

Question Title

* 2. Do you live in Ovingdean?

Question Title

* 3. What can you help with?

Question Title

* 4. Do you use WhatsApp? WhatsApp could be used as a way to communicate with volunteers as requests come up as it is quick and easy to use (WhatsApp is an App used on Smart phones, a bit like a group text).

Question Title

* 5. Do you have any concerns you might have for yourself that you would like us to be aware of? (You don't have to answer this but it helps us to identify if you might need additional support). Tick any or all that apply:

Question Title

* 6. When, generally, could you volunteer? Please tick any that apply.

Question Title

* 7. I have some specific concerns or questions (please state here):

Question Title

Question Title

* 4. Do you use WhatsApp?
WhatsApp could be used as a way to communicate with volunteers as requests come up as it is quick and easy to use (WhatsApp is an App used on Smart phones, a bit like a group text).