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Volunteer at Santa Monica Facility

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Volunteer at Santa Monica Facility

  • Forms to Bring To Check-In Day
  • Student Volunteers
  • Non-Student Volunteers
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  • Companion Care Program
  • Forms to Bring To Check-In Day
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  3. Forms to Bring To Check-In Day

Forms to Bring To Check-In Day

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Students are required to study the training materials posted on this web-page (see the links provided below) prior to your attendance. You must then print, complete, and bring with you all forms which will be collected

at the orientation. Allow yourself four weeks before Orientation Day to gather all themandatorypaperwork andimmunizations. You will receive 4 hours of service credit for completing all paperwork.

You will need Adobe Acrobat to open the following PDFs . For a free copy of this program, please visit Adobe Acrobat website.

Training Materials to Study (Do not print):

  • Orientation Guide
  • Volunteers' Assignment List
  • Dress Code

Forms to Print, Complete and Bring with You to Check-In Day:

  • Coversheet and Acknowledgement Form
  • Volunteer Agreement
  • Abuse Reporting Forms (Signature Forms)
    • Elder
    • Child
    • Domestic
  • Volunteer Service Description
  • Tdap Declination

IMPORTANT: You will need to generate a temporary I.D. to complete the following On-line training modules. Please note that the HIPAA training has two pages to print, along with a required signature.

  • HIPAA Privacy and Information Security Training
  • CICARE Annual On-Line Training
  • Safe Patient Handling Training
  • Volunteer Services Training
  • Radiation Safety Training 

What immunizations are required to volunteer?

The following below are the immunizations required in order to volunteer. Applicants must bring a copy (they will not be returned) of their immunization records to Check-In Day (see page 8 in the Orientation Guide

listed above). UCLA has very specific requirements for immunizations in order to volunteer. Applicants must provide proof for all of the following below. Please make note of which immunizations require

TWO vaccinations, and/or provide proof of a blood indicating immunity.

UCLA STUDENTS: UCLA Students are required to BRING medical documentation (proof) of their:

    1. TB blood test results
    2. Flu (Influenza) Vaccine (during Flu Season only)
    3. AND provide a Health Clearance Letter from UCLA Student Health Ashe Center. 
    4. Please read the instructions on how to obtain that letter: Instructions for completing UCLA Health – Volunteer/SRP Health Clearance Requirement

NON-UCLA STUDENTS: Please BRING your medical documents of the following immunizations and health screening test results

1. Measles, Mumps, and Rubella (MMR)

  • Medical documentation of TWO MMR vaccinations

OR

  • Medical documentation of ONE BLOOD TITER indicating immunity to MMR
  • Disease history of MEASLES, MUMPS, and RUBELLA will not be accepted.

2. Varicella (Chickenpox)

  • Medical documentation of TWO VARICELLA vaccinations

OR

  • Medical documentation of ONE BLOOD TITER indicating immunity to VARICELLA
  • Disease history of CHICKENPOX will not be accepted.

3. Tuberculosis (TB) Screening

If you have always tested negative for TB, please provide:

  • Medical documentation of a QuantiFERON-TB Gold (also known as QFT-G) blood test completed within the last 3 months.

If you have previously tested positive for TB, please provide:

  • Documented proof of a positive QuantiFERON-TB Gold (also known as QFT-G) blood test (documentation of positive TB from any date will be sufficient).

                                       AND

  • Medical documentation of a chest radiograph (chest x-ray) report within the last 3 months

4. Tetanus, Diphtheria, Pertussis Vaccine (Tdap)

  • Medical documentation of Tdap vaccination

OR

  • Signed Tdap declination if unable to provide medical documentation.

5. Flu Vaccination

  • Only applicable during flu season.

Due to the COVID-19 pandemic and the need to limit the individuals coming into the hospital, all volunteer programs at UCLA Health are currently on pause until further notice.

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