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  • Date: - Volunteer Assessment Survey: First Name

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    Gilbert Cook
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    This document is a volunteer assessment survey for a hospital volunteer services department. It requests information such as name, address, phone number, email, availability, interests in different hospital departments, skills, qualifications, and previous volunteer experience. Volunteers are placed in regular weekly assignments that may be available from early morning to late evening, 7 days a week, with some evening and weekend opportunities. Departments listed for potential placement include admitting, surgery, patient transport, clerical work, and others.

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    Assessment Survey

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    This document is a volunteer assessment survey for a hospital volunteer services department. It requests information such as name, address, phone number, email, availability, interests in different hospital departments, skills, qualifications, and previous volunteer experience. Volunteers are placed in regular weekly assignments that may be available from early morning to late evening, 7 days a week, with some evening and weekend opportunities. Departments listed for potential placement include admitting, surgery, patient transport, clerical work, and others.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    27 views3 pages

    Date: - Volunteer Assessment Survey: First Name

    Uploaded by

    Gilbert Cook
    This document is a volunteer assessment survey for a hospital volunteer services department. It requests information such as name, address, phone number, email, availability, interests in different hospital departments, skills, qualifications, and previous volunteer experience. Volunteers are placed in regular weekly assignments that may be available from early morning to late evening, 7 days a week, with some evening and weekend opportunities. Departments listed for potential placement include admitting, surgery, patient transport, clerical work, and others.

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    © All Rights Reserved
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    of 3

    Volunteer Services, A1-26

    79-01 Broadway
    Elmhurst, NY 11373
    718-3345175
    EHCVOLSERV@nychhc.org

    Date: _____ Volunteer Assessment Survey


    First Name:

    Last Name:

    Home Address:

    Home Phone:

    Cell Phone:

    Email Address:

    Date of Birth

    Referred By:

    Availability:
    Volunteers are placed in a regular weekly assignment. Some assignments are available seven days a week,
    early morning through late evening. There are limited evening and weekend assignments. Please check your
    availability below. This information will help us determine the possible position openings that may be of
    interest to you.

    Shift Monday Tuesday Wednesday Thursday Friday Saturday Sunday

    8 AM – 12 PM

    1 PM – 5 PM

    5 PM – 8 PM
    The following are a few departments where volunteers can work:
     Admitting Department
     Ambulatory Surgery
     Ambassador Program (Meet, greet and assist patients and families)
     Cancer Patient Support
     Clerical
     Emergency Department
     Inpatient (Visiting patients and providing non-clinical support)
     Outpatient (Lobby rounds, clerical support, stock supplies)
     Patient Advocacy
     Patient Transport
     Pharmacy Department
     Physical & Occupational Therapy
     Radiology Transport
     Special Programs (Healthy Outlook & After School Programs)
     Spiritual Care Department

    From the list above, please list your top three in order of highest interest to you:

    1) _________________________________________

    2) _________________________________________

    3) _________________________________________

    Special skills and qualifications you have acquired from employment, previous volunteer work, or
    through other activities, including hobbies or sports:

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    Previous volunteer experience:


    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

    _________________________________________________________________________________________

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