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Forms Required

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* Forms due upon acceptance into the program

Deadlines 

Required Paperwork due Tuesday, July 7th by NOON

Immunizations due Tuesday, July 29th by NOON

Study the essential training materials posted on this webpage (see the links provided below) . Allow yourself enough time to gather all the required paperwork and immunizations.

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:

  • Orientation Guide
  • Volunteers' Assignment List
  • Dress Code
  • Abuse Reporting
  • Sexual Harassment

Required Paperwork

  • Checklist
  • Coversheet and Acknowledgement Form (Signature required)
  • Volunteer Agreement (Signature required)
  • Abuse Reporting Forms (Sign all 3 forms!)
    • Elder
    • Child
    • Domestic
  • Tdap Declination (Signature required)
  • Medical Clearance Form - under 18 years old (Must be signed by your physician!)
  • Volunteer Workers Compensation Coverage

IMPORTANT: You will need to generate a temporary I.D. to complete the following training modules if you do not have a Bruin number.           

SAVE AND BE READY TO SUBMIT ALL CERTIFICATES OF COMPLETION (Certificate is produced after training module is complete)

  • HIPAA Privacy and Information Security Training
  • CICARE Annual On-Line Training
  • Safe Patient Handling Training
  • Volunteer Services Training
  • Radiation Safety Training (Can only be completed on Internet Explorer)

Immunizations

Produce a copy (copy will not be returned to you) of immunization records (see page 12 in the Orientation Guide listed above). UCLA Health has very specific immunizations requirements for volunteers.

Documentation required:

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.

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.

Tuberculosis (TB) Screening

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

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

                                        OR

  • Medical documentation of NEGATIVE TB SKIN 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) OR positive TB Skin test

                                       AND

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

Tetanus, Diphtheria, Pertussis Vaccine (Tdap)

  • Medical documentation of Tdap vaccination                              
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