Fresh Food Fresh Start Foundation

Volunteer Program
Manual

Michael Darone, Maria La Fontaine, and Jose Zambrano

Table Of Contents

Organization's Overview………………………………………………………………………….3

Our Mission………………………………………………………………………………….........3

Our Vission………………………………………………………………………………………..3
Our Core Values………………………………………………………………………………...3-
4

Our LOGO………………………………………………………………………………………...4

Our Volunteer
Numbers…………………………………………………………………………..4

Volunteer Availability…………………………………………………………………………...4-
5

Standards and Guidelines for Volunteers…………………………………………………….5-10

Equal Opportunity Policy………………………………………………………………………...5

Non-Discrimination Policy…………………………………………………………………….…5

Code of Conduct………………………………………………………………………………..5-6

Harassment Policy………………………………………………………………………….…….6

Rights/Responsibilities………………………………………………………………………….6-7

First Aid/Emergency Procedures………………………………………………………………...7

Age Requirements………………………………………………………………………….……..7

Health Requirements……………………………………………………………….…………….8

Allergen Warning……………………………………………………………………………..…..8

Personal Belongings…………………………………………………………………...…………8

Dress Code……………………………………………………………………………………...…8

Volunteer Job Description………………………………………………………………………..8

Volunteer Recruitment and Types………………………………………………………………..9

Signing up to Volunteer…………………………………………………………………………..9

Background Check and Fingerprinting………………………………………………….………9

Volunteer Orientation……………………………………………………………………...……..9

Plan B…………………………………………………………………………………..…………9
Liability…………………………………………………………………………………….…….10

Crisis Communication…………………………………………………………………….….…10

Incident Reports……………………………………………………………………………..…..10

Social Media
(Examples)……………………………………………………………….…………………...….10

Volunteer Statistics Tracking and

Scheduling…………………………………………..……...10

Volunteer Recognition Plan (Importance, Rewards,

Annual Card, Long Term Gratitude)………………………………..………………....…....10-11

Program Evaluation
(Examples)………………….………………………………………………………………....…12

Future Plans…………………………………………………………………………...………...12

References……………………………………………………………………………………….13

Job Descriptions(Food Pantry and On- Call Volunteers)......................................................14-

17

All Forms are Attached to the back of the Manual

Our Organization

 Fresh Food Fresh Start Foundation (FFFS)

 Non-Profit
 Services: We provide easily accessible and affordable fresh food. We provide fresh food
in supermarkets, corner stores, and farmer markets. We also help promote and provide
healthy meals to the community.
  Population/s Served: Low income families that cannot afford fresh food and families that
do not have easy access to fresh food.

Organization’s Overview

Fresh Food Fresh Start is a Non-Profit organization that helps families in need of fresh
food. Our organization believes in helping the community to be able to acquire fresh food easier.
We believe that fresh food allows families to be able to get a leg up in life by staying
healthy. Fresh food and ingredients may be hard to get and low income families are having a
hard to getting access and support. We provide food mobility services by making food more
accessible and affordable for families in need. We have partnered with many different
organizations to help our organization be successful.

Our Mission

Fresh Food Fresh Start’s mission is to ensure that everyone has easy access to fresh and
affordable food to help create and maintain a healthy lifestyle.

Our Vision

Fresh Food Fresh Start’s vision is to create a new world that has easy access to fresh food and
ingredients while maintaining affordability to help live a healthier lifestyle.

Our Core Values

 Value ONE: Passion

- We have the drive to do something greater for the community by the use of
our organization.
 Value TWO: Integrity
- We honor our commitment that we make to others and ourselves.
 Value THREE: Service
- We serve our community to the fullest of our ability to allow the best outcome
 Value FOUR: Inspire
- We want to take the time to inspire people to better themselves not only by
food but other means as well.
 Value FIVE: Relationship
- We take great value in building and maintaining relationships to help our
community and organizations to go above and beyond our purpose.
 Value SIX: Excellence
- We strive for the best outcome that we can obtain 100% of the time.
Our LOGO

Our logo represents a human being having easy access to fresh produce. By having fresh food
he/she is able to smile which help demonstrates a good life. “Fresh Food = A Good Life”

Our Volunteer Numbers

  Fresh Food Fresh Start does not have any specific number of volunteers that are
needed. Fresh Food Fresh Start is always recruiting volunteers. By Fresh Food
Fresh Start always recruiting we have a surplus of volunteers so we do not every
run low on the need for volunteers. This allows us to work to the highest
capability of effectiveness and efficiency. This keeps our volunteer culture happy
which allows our volunteers to stay with us for a longer amount of time. The main
reason to always recruit is to reach our future goal of being able to expand Fresh
Food Fresh Start across the country.
 On a daily basis we use anywhere between 10 to 20 volunteers.
 On a weekly basis we usually use anywhere between 20 to 35 volunteers. For
special events we usually use anywhere between 30 to 40 volunteers because we
need people at the special event and people to that are part of the normal
volunteer routines.
 On a monthly basis we use anywhere between 50 to 120 volunteers.
 Annually, we average the use of roughly 200 volunteers to help Fresh Food Fresh
Start function on such a high level.

Volunteer Availability

 Fresh Food Fresh Start is always recruiting which means we have a surplus of
volunteers. We can always use the extra help so that is why we keep so many on
staff. If a volunteer is unavailable, we have plenty of volunteers on staff and
others that we are able to call to see if they can come in. It is very easy for us to
work around volunteers schedules because of the amount of volunteers that we
keep.
 If a volunteer does not show up, we have plenty of people on staff and to call in if
we have too. Like stated earlier Fresh Food Fresh Start keeps our volunteer
reservoir full so we do not run into staffing problems.
 No Call, No Shows will be handled by the supervising staff because we expect
our volunteers to be there when a commitment is made. Too many No Call, No
Shows may result in being asked to leave the organization.

Standards and Guidelines for Volunteers

Equal Opportunity Policy

Fresh Food Fresh Start (FFFS) maintains a strong policy of equal volunteer opportunity. We
recruit, accept, train, and dismiss volunteers on the basis of personal competence and position
performance, without regard to race, creed, religion, sex, sexual orientation, age, marital status or
handicap.

Non-Discrimination Policy

It is the policy of FFFS that there will be no discrimination or harassment in its programs,
activities, or employment based on race, color, sex, sexual preference, marital or parental status,
religion, national origin, age, mental or physical disability, or veteran status. Questions or
concerns related to affirmative action, non-discrimination or equal opportunity should be
directed to the Volunteer Manager.

Code of Conduct

FFFS is a community-based organization dedicated to providing engaging volunteer

opportunities. Participation in the organization's Volunteer Program is subject to the observance
of the organization's rules and procedures.The activities outlined below are strictly prohibited.
Any participant who violates this Code is subject to discipline, up to and including removal from
the program.
 Possession or use of alcoholic beverages or illegal drugs on
Forgotten Harvest's property or reporting to the program while
under the influence of drugs or alcohol.
 Bringing dangerous or unauthorized materials such as explosives,
firearms, weapons or other similar items.
 Discourtesy or rudeness to a fellow participant, staff member or
volunteer.
 Abusive language towards a staff member, volunteer or another
participant.
 Verbal, physical or visual harassment of another participant, staff
member or volunteer.
 Actual or threatened violence toward any individual or group.
 Conduct endangering the life, safety, health or well-being of
others.
 Failure to follow any agency policy or procedure.
 Bullying or taking unfair advantage of any participant.
 Failing to cooperate with an adult supervisor/leader/mentor.
 Any act that involves theft of any kind.

Harassment Policy

It is the policy of Fresh Food Fresh Start to promote an environment free from sexual or
discriminatory harassment. With regard to sexual harassment, FFFS prohibits supervisors,
employees, and nonemployees from the following behaviors considered sexual harassment under
the Code of Federal Regulations:
 Unwelcome sexual advances
 Request for sexual favors
 Verbal conduct of a sexual nature including jokes, remarks, or
similar
 Any physical conduct that could be construed to be of a sexual
nature
 Any similar related behavior, whether of a verbal and/or physical
nature, which has the purpose or effect of interfering with an
Employee's/Volunteer's work performance and/or creation of an
intimidating, hostile, or offensive work environment; or when the
 submission to such conduct is made either explicitly or implicitly a
term or condition of an individual's employment; or when the
submission to or rejection of such conduct by an individual is used
as basis for employment decisions affecting such individual; or
when such conduct has the purpose or effect of unreasonably
interfering with an individual's work performance or creating an
intimidating, hostile, or offensive working environment.
 Additionally the determination of whether such conduct constitutes
sexual harassment will be determined from the “record as a whole,
totality of the circumstances and upon a case by case analysis.”

Rights/Responsibilities

 To be open and honest regarding intent, goals, and skills.

 To accept only realistic assignments and have a clear understanding of the job.
 To carry out duties promptly and reliably.
 To accept the guidance and direction of your volunteer manager and fellow
volunteers.
 To participate in any training required by the agency.
 To respect confidentiality.
 To discuss satisfactions, dissatisfaction, and suggestions for upgrading or
changing of volunteer assignments with your volunteer manager.
 To be punctual, and notify your volunteer manager of absences as much in
advance as possible.
 To be alert, sober, and drug free while volunteering.
 Accept those assignments suited to personal interests, talents, and skills.
 Participate in orientation.
 Learn about and uphold FFFS policies, programs, and people.
 Act professionally which includes respecting all confidences.
 Complete all assignments
 Be willing to use and teach new Ideas.
 Volunteers are viewed as the most valuable resource of this agency, its staff, and
its clients.

Volunteers have the right to be given meaningful assignments, the right to be treated as equal co-
workers, and the right to effective supervision. Volunteers have the right to full involvement and
participation, and the right to recognition for work done. In return, volunteers shall agree to
perform their duties to the best of their abilities. They will remain loyal to the goals of the
agency and operate according to its procedures.

First Aid/ Emergency Procedures

At Fresh Food Fresh Start we strive to ensure a safe place to volunteer, and it is the responsibility
of each volunteer to adhere to the following:

 Work according to good safety practices as posted, instructed and discussed.

  Refrain from any unsafe act that might endanger oneself, the people we serve or our co-
volunteers.
 Use all safety devices provided for your protection- failure to comply with safety
requirements could result in immediate dismissal.
 Report any unsafe situation or acts immediately to your volunteer supervisor.
 Fires or emergencies should be reported to the supervisor. If evacuation is called for,
volunteers should use the closest unaffected exit in a quick and calm manner. Move as far
away from the building as possible for your safety and make room for emergency
vehicles.
 First aid kits are located in the front office and the warehouse manager’s office. In the
event someone is in need of first aid, direct them to one of the first aid stations. In the
event of an accident or injury, notify a staff person immediately. Call 911 for an
emergency.
 If you are injured, report your injury to your supervisor. You will be asked to fill out an
accident report.

Age Requirements

All youth groups must register with the Volunteer Manager. Youth must be a minimum of 15
years of age to volunteer at FFFS with a chaperone.

Health Requirements

For the safety and health of our recipients, if you are sick (even with a mild cold, sore throat,
sniffles etc) we ask for you to not volunteer until being fully better.

Allergen Warning

Fresh Food Fresh Start at any given time can have and may have processed any type of fresh
produce. Please be aware of your safety and allow your supervisor to know about your allergies..
You and our stakeholder’s safety are very important and we do not wish to take any chances that
you may have an allergic reaction.

Personal Belongings

We recommend you leave all personal items and valuables at home. We do have lockers and you
will be assigned a lock and key if you wish to lock up your personal belongings at our facility.
Fresh Food Fresh Start is not responsible for any lost or stolen items.

Dress Code

Please adhere to the following dress code or you will not be allowed to volunteer: You must
wear closed toed shoes. No flip flops, sandals or high heels. Please wear appropriate clothing
according to the weather because we have both inside and outside assignments. Anything with
inappropriate words or images will result in being sent home. If you are unsure please just give
us a call or email us and ask.

Volunteer Job Description

The following are various jobs that may be required by Volunteers of our organization:
 Organize food into individualized or family portions
 Lift and carry boxes of fresh foods
 Transport fresh foods to drop off location
 Support and facilitate distribution of fresh foods
 Share and teach the community about the importance of fresh foods
 Clean up all site locations
 Volunteer coordinator
 Stocker and inventory
 Driver and transportation aid
 Maintain a healthy working relationship amongst all team members and the community

Volunteer Recruitment & Types

All volunteers will be subject to application procedures listed in this manual. Volunteers will be
encouraged and recruited from philanthropic groups, high schools, colleges, and other
businesses/organizations that uphold the same core beliefs and values. Volunteers are needed on
a regular basis, therefore our organization needs a continuous support system from our
volunteers. All volunteers will have to apply, be interviewed, attend an orientation and continue
to uphold the code of conduct and core values of our organization.

Signing up to Volunteer

All Volunteer must sign up at the main office or online at our website. Fresh Food Fresh Start
has a first come first serve policy. This policy allows us to view everybody’s applications for
volunteering in the order in which we received them to give everybody a fair chance. We are
always in need of responsible volunteers so there is no waiting list.

Background Check & Fingerprinting

Prior to orientations all volunteers and staff members are required to allow a background check
and must be fingerprinted through the county. Fresh Food Fresh Start will take care of both the
Background Check and Fingerprinting.

Volunteer Orientation

Volunteers are required to attend one of the three Fresh Food Fresh Start’s monthly scheduled
volunteer orientations. Orientations will include information on food handling, food safety, our
programs core values and community outreach. If a volunteer cannot make any of the scheduled
orientations please contact the organization and we will try and work out another alternative.
Firing Volunteers

Volunteers will be fired on a basis of violating any of the items listed in our Code of Conduct in
this manual. Our participants all sign a policy agreement form and we hope them up to that
standard.

Plan B

Due the the excessive amount of volunteers that we have and our updated program software we
have developed an on-call volunteer program that covers volunteer shifts on-call when they can
not make their shift within a reasonable time. This volunteers are mobile and are ready to sub in
at any time. We rely on their dedication to come on-call and express our gratitude frequently.

Liability

All volunteers (parent/guardian for those under the age of 18 years of age) must sign the attached
liability waiver before each volunteer event. If you registered online or already submitted a
volunteer liability waiver within the last 2 years, you do not need to submit another one.

Crisis Communication
In case of an emergency please call 911 first. We also have a 24 hour tech specialists who help
with website issues, problems logging into the volunteer portal, and assignment issues. For
physical crisis issues please refer to our First Aid/ Emergency Procedures.

Incident Reports

All incidents will need to be reported.An Incident Report is attached in this manual and must be
submitted within 24 hours if an incident should occur. It is to then be turned into the Volunteer
Supervisor. Please refer to our First Aid/ Emergency Procedures.

Social Media

Fresh Food Fresh Start Foundation is happy to be caught up with today's technology and social
media outlets. We use twitter, facebook and instagram to stay connected with our community
and post which neighborhood we will visit that day as well as post pictures of our events to
promote outreach. We ask that you follow us on social media and like our page.

Example Posts

IG: Please join us today from 5PM-7PM at the Cesar Chavez Park in downtown Sacramento we
will be having 2 of our Fresh Food Fresh Start available for community members to purchase
local and affordable produce.

Facebook: Mark your calendars! The peach festival is nearly upon us! Join in all the fun as we
join local businesses to provide produce to community members at Sutter Park.
Volunteer Statistics Tracking and Scheduling

All volunteers hours will be tracked on our online tracking system. Volunteers will create an
online profile during initial orientation. Volunteers will sign up for volunteer opportunities
online ahead of time. If volunteers show up the day of the event, it is their responsibility to enter
it online following the event. This will ensure that volunteer hours are tracked and individuals
are notified when volunteers are needed for specific events. This system will also track what
trainings individuals have received. This tracking system will enable us to thoroughly recognize
each volunteer for their individual contribution to our organization. It will also ensure no
overlap or lack of volunteers for specific opportunities. The main mode of communication with
volunteers will be through email.

Volunteer Recognition Plan

Importance of Recognition

Without the help of volunteers we would not be able to accomplish of mission. When money is
spent to pay staffing, it is taking away money that could be spend on our cause. Money that
could be used to help directly benefit an individual. Fresh Start Fresh Food Foundation hopes
that all volunteers feel appreciated. Our volunteers should have a sense of belonging.

It is important to recognize volunteers for their time and skill contribution to promote individuals
to continue to come back and serve. It is much easier to have a volunteer come back rather than
to recruit and train more individuals. This is why we strive to ensure that our volunteers feel
welcomed, prepared, and appreciated.

We believe that recognition is an important element when promoting volunteer return.

Relationships between Fresh Start Fresh Food Foundation and their volunteers take time and
effort. William Arthur Ward wrote, “Feeling gratitude and not expressing it is like wrapping a
present and not giving it.” We wish to express our gratitude with every opportunity available.
We have a designated volunteer recognition team under our volunteer coordinator. This position
ensures that volunteers feel part of the team and recognized for their time contributed. In
addition, continues to research more ways of recognition.

Rewards and Recognition

For office volunteers name badges are given to ensure sense of belonging just like staff
members. Many organizations are purchasing and supplying volunteer t-shirt for participants to
feel unified as an organization. We have started an annual contest to see who can create the best
volunteer t-shirt design. This allows volunteers to submit their designs. We are seeking the
support of our sponsors and local businesses to help pay the expense and in return benefit by
having a logo or acknowledgment in promotional materials such as back of t-shirts, newsletter,
flyers and media releases.

Annual cards
Having a designated volunteer recognition person is important. This person knows when
participants birthday are, how many months/years the participant has been with the organization
for, and time committed to specific projects. Volunteers receive annual birthday cards,
reminding them that we are thinking about them and are happy to celebrate another year of life
for them. As well as regular thank you cards to thank them for their support and include
upcoming volunteer opportunities to remind them about the organization and that the cause is
still in need of continuous volunteers.

Long Term Gratitude

Just like any organization, there are volunteers who contribute years of service. For these
volunteers, we host a formal event to thank them for their commitment and gratitude. These
types of formal events include formal dinners, awards ceremony, or parties. During which we
acknowledge volunteers and give out nominated awards.

Program Evaluation

Feedback is a critical component to growth in any organization. Fresh Food Fresh Start
Foundation uses a variety of methods to survey. We continuously ask volunteers their opinion or
suggestion after training is important to ensure they understood. This should happen frequently
and can include asking in person questions during the interview, orientation, and training. As
well as throughout their length of volunteering with the company. Individual’s perspectives
change with events and projects given.

Example Evaluations

Another tool used to promote organizational feedback is surveys. Surveys help record specific
trigger answers and give us better results. Questions in the survey should align with the mission
statement. Did the participant feel like they knew what they were committing to? Did they feel
that their contribution was worth it? These are important questions to ask to avoid continued
confusion and begin possible description restructure.

Surveys also help gather information in tables so that statistics are shown for successes and areas
of improvements. Funders, sponsors and volunteers all have access to view the results and
numbers. This information is shared with the public as well. It is okay to find mistakes and
misunderstanding in the organization. “It’s a balance of trial and error until you get it right.”

Future Plans

With these results we should be able to determine mistakes, missed opportunities, and areas of
improvements. We encourage volunteers to be honest with us and we accept all forms of
feedback. With these results we will continue to work on strengthening our outreach strategies,
trainings, and promoting. No organization is perfect but the first thing to perfection is continued
improvements.
 Reference Page

Ibele, T. (2011, October 27). Volunteer Appreciation Guide | Wild Apricot Membership
Knowledge Hub. Retrieved November 11, 2017, from
https://www.wildapricot.com/articles/volunteer-appreciation-guide#recognition

Sadiq, B. (2016, September 02). Metrics for Success: Evaluating Your Volunteer Program.
Retrieved November 11, 2017, from
https://blogs.volunteermatch.org/engagingvolunteers/2016/09/02/metrics-for-success-evaluating-
your-volunteer-program/

Food Pantry Inventory Volunteer

Under the direction of the volunteer supervisor, the food pantry Inventory Volunteer will have a
wonderful opportunity to help those in need of easy access and affordable food in their local
neighborhood.

Essential Duties and Responsibilities:

· Organize, sort and stock all incoming food items, including loading and
unloading of freezers and shelves.
· Will assist with unloading our van when it returns from the local event and local
grocery stores.
· Check for expiration dates and discard as needed
· Maintain orderliness and cleanliness of the panty and waiting area
· Promote and ensure safety procedures are followed by staff, volunteers and
community members.
· Refer customer issues and complaints to appropriate staff for resolution.
· Complete all required records and reports daily.
· Other duties as assigned.
Minimum Requirements:
· Any combination of experience and education that could likely provide the
required knowledge and abilities.
· Knowledge of basic food serving techniques.
· Willing to obtain a food handler's card within 30 days of start.
Ability to:

· Lift up to 10 pounds.
· Work with other volunteers.
· Provide excellent customer service.
· Must be able to stand, walk, bend and lift.
· Understand and follow written and oral instructions and communicate clearly.
· Demonstrate sound judgment and time management skills.
· Multitask and prioritize projects.
Special Requirements:
· DOJ Fingerprint.
· Background check.
· Sign a volunteer release and waiver of liability form
Days and Time needed:
· Monday- Saturday varies shifts. Please give your availability to the volunteer
superiors.
· (a min of one 3-hr shift per week commitment required)
 On-Call Volunteer

Under the direction of the volunteer supervisor, the on-call volunteer will have a wonderful
opportunity to help those in need of easy access and affordable food in their local neighborhood
when a volunteer calls out or emergency relief is needed.

Essential Duties and Responsibilities:

• Organize, sort and stock all incoming food items, including loading and unloading of
freezers and shelves.
• Will assist with unloading our van when it returns from the local event and local grocery
stores.
• Check for expiration dates and discard as needed
• Maintain orderliness and cleanliness of the panty and waiting area
• Promote and ensure safety procedures are followed by staff, volunteers and community
members.
• Refer customer issues and complaints to appropriate staff for resolution.
• Complete all required records and reports daily.
• Other duties as assigned.

Minimum Requirements:

• Possession of a valid California driver’s license or have reliable transportation.

• Any combination of experience and education that could likely provide the required
knowledge and abilities.
• Knowledge of basic food serving techniques.
• Willing to obtain a food handler's card within 30 days of start.

Ability to:

• Lift up to 10 pounds.
• Work with other volunteers.
• Provide excellent customer service.
• Must be able to stand, walk, bend and lift.
• Understand and follow written and oral instructions and communicate clearly orally.
• Demonstrate sound judgment and time management skills.
• Multitask and prioritize projects.

Special Requirements:

• On-call volunteer opportunities.

• DOJ Fingerprint.
• Background check.
• Sign a volunteer release and waiver of liability form

Days and Time needed:

• Monday- Saturday varies shifts. Please give your availability to the volunteer superiors.
• (a min of one 3-hr shift per week commitment required)
 VOLUNTEER RELEASE AND WAIVER OF LIABILITY FORM

This Release and Waiver of Liability (the “release”) executed on this ______ day of _____________, 2017,
by_________________________________ hereby releases the following Persons and Entities Released and otherwise
agrees to the following.

The Volunteer desires to provide volunteer services and engage in activities related to serving as a volunteer for Fresh
Food Fresh Start Foundation hereby agrees:

1. WAIVER AND RELEASE: I, the Volunteer, release and forever discharge and hold harmless the above listed entities
from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or
may hereafter arise from the services I provide. I understand and acknowledge that this Release discharges from any
liability or claim that I may have with respect to bodily injury, personal injury, illness, death,or property damage that
may result from the services I am providing for The Event.

2. INSURANCE: Further I understand that none of the above participating entities assumes any responsibility for or
obligation to provide me with financial or other assistance, including but not limited to medical, health or disability benefits or
insurance of any nature in the event of my injury, illness, death or damage to my property. I expressly waive any such claim for
compensation or liability on the part of the participating entities.

3. MEDICAL TREATMENT: I hereby Release and forever discharge the participating entities from any claim
whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered
in connection with an emergency during my tenure as a volunteer with the Event.
4. ASSUMPTION OF RISKS: I understand that the services I provide to the organization may include activities that may
be hazardous to me including, but not limited to involving inherently dangerous activities. As a volunteer, I hereby expressly
assume the risk of injury or harm from these activities and Release ALL participating entities from all liability for injury, illness,
death, or property damage resulting from the services I provide as a volunteer or occurring while I am providing volunteer
services for organization

5. PHOTOGRAPHIC RELEASE: I grant and convey to the Fresh Food Fresh Start Foundation all right, title, and
interests in any and all photographs, images, video, audio in connection with my providing volunteer services for the
organization.

6. OTHER: As a volunteer, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the
laws of the State and that this Release shall be governed by and interpreted in accordance with the laws of the State. I agree that
in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this
Release shall not be affected.

By signing below, I express my understanding and intent to enter into this Release and Waiver of Liability willingly
and voluntarily.

________________________________ ___________
Signature Date

If volunteer is under the age of 18, a parent/guardian must read and sign this Release/Waiver of Liability form.

__________________________________ ____________
Parent or Guardian Date

Incident Information Report

(Events or allegations of injury, illness, or property damage, including employment and issues with directors and
officers)

Incident date: ___________________ Time: ____________________________________________________

Reporting date: _________________ Time: ____________________________________________________

Council/BSA location: ________________ ❏Leader ❏Parent ❏Other: __________________________________

Reporting person _______________________________________________________________________________

Location of incident: ____________________________________________________________________________

Specific area where incident occurred:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
Cause of incident:
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Program/event/adventure code: ____________________________________________________________________

Did the incident occur while transporting to/from an activity? ❑Yes ❑No

Comments:
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Individuals Involved (Duplicate If Needed)

Name:_______________________________________________________________________________________

Address: _____________________________________________________________________________________

Home phone: _______________Cell phone: ________________Work phone: ______________________________

DOB:___________________Age: _______Unit No.: _______________Council:____________________________

Scouting role: _________________________________________________________________________________

Type of injury or property damage: _________________Injured body part: ________________________________

Was medical treatment given at scene? ❑Yes ❑No Type:______________________________________________

Medical disposition (transported to hospital, etc.):_____________________________________________________

Return this completed form to your volunteer supervisor.