Research & Academic Volunteer Services
JOB SITE INFORMATION
Prepared by:
Preparer title:
Preparer phone:
Host Site Information
Site name (program, department, etc.):
Campus: Marquam Hill
Other:
Supervisor phone:
Supervisor name:
Building/Room:
Volunteer Information
Name:
Date of birth:
Minor: No
(If yes, review, sign & file “Guidelines
for Hosting Minors in Labs”)
E-mail:
Status:
New
Returning
Phone:
Requested start date:
Additional assignment
Resubmission (duties have changed)
Scheduled hours per week:
Anticipated end date:
Position Details
Volunteers must be supervised at all times. For more information about assigning duties, see RAVS website here
Research Duties
Use this section to list research duties performed in this volunteer role.
This is not an exhaustive list; please outline all other duties in the “other” section.
Maintain records for
Collect and prepare
Clean supplies and
Pipetting / solution
experiments
samples
equipment
preparation
Screen study applicants
Data collection/analysis
Cell biology
Literature searches
Neuropsychological testing
Work with chemicals (must review MSDS with volunteer)
Obtain research participation consent (low risk studies only; volunteers must receive IRB approval)
Interacting with research subjects (provide detail):
Are the research subjects also currently being treated [as patients] by OHSU? No
Non-NHP animal research (provide detail):
Other (describe any other duties not outlined above – e.g. gel electrophoresis, PCR, Immunochemistry, assays, etc.):
Administrative Duties
Use this section to list administrative duties performed in this volunteer role.
This is not an exhaustive list; please outline all other duties in the “other” section.
Answer phones/greet
visitors
Making copies
Other:
Correspondence
Data entry
Mailing
Special events
Community liaison
work
Filing
Other Duties
Interacting with patients (provide detail). Use this section to describe how the volunteer will be interacting with patients. Example:
Volunteer will assist patients and their families obtain research and information within the BrainNet Library.
Professional program support (provide detail). Use this section to describe professional skills provided to support existing program.
Example: Volunteer will use skills as a Licensed Clinical Social Worker to facilitate a support group for patients.
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Observing (provide detail). Use this section to describe any observing the volunteer will be doing in addition to duties outlined above.
Example: Volunteer will shadow Dr. Blake in Orthopaedic clinic twice a month.
Physical demands (provide detail). Use this section to describe the physical requirements necessary to perform the essential functions of
this position. Example: Ability to carry and lift up to 50 pounds. Ability to stand for four continuous hours.
Fluids, Tissues & Biological Hazards
Use this section to list fluids, tissues and biological hazards the volunteer may handle, or come in contact with.
This is not an exhaustive list; please outline all other fluids, tissues and biological hazards in the “other” section.
Human tissue (fixed),
blood, and body fluids
Human cell lines (provide
detail):
Non-Human Primate
tissue (fixed), blood, and
body fluids
Infectious agents
(provide detail):
Other animal tissue
(fixed or unfixed) (e.g.
Regulated medical
waste/ biological waste
rodent, etc.)
Recombinant DNA
Radioactive materials
Other (items above are the only approved exposures for volunteers. Others can be listed and will be reviewed on a case by case basis):
Equipment
Use this section to list equipment the volunteer may handle, or come in contact with.
This is not an exhaustive list; please outline other equipment in the “other” section.
MRI/X-ray
Microscopes (provide detail):
Other:
Ultrasound
Centrifuge
ID Badge Information
ID BADGES are issued once the volunteer has completed all compliances. Volunteers cannot begin their assignment until a badge is issued. Badges
are $25 and can be paid for by the hosting department or by the volunteer. Please indicate below:
Paid for by hosting site
Alias:
FAID:
Special ID Badge Access (if needed):
Paid for by volunteer
West Campus ID badge
Required Approvals
Signatures need to be obtained in the following order:
Volunteer supervisor
Name:
Sign:
Date:
Department approval (e.g. Department Head, Administrator, etc.)
2
Name:
Sign:
Date:
Submit to RAVS for processing with a Background Disclosure Request form
Research & Academic Volunteer Services
Tuberculosis Screening Required:
3 Sign & Date:
1
EHRS Safety Officer (if applicable)
4 Sign & Date:
Risk Management (if applicable)
Sign & Date:
Volunteer Sign & Date:
6
Name:
Volunteer guardian (if minor)
7
Name:
5
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Exempt
TB Patient Areas
TB Patient Contact (& N-95 Mask Fitting)
Other/comments:
Training Required:
General Safety & Laboratory Safety Training
Bloodborne Pathogen Training
Other/comments:
Comments:
Sign:
Date:
Sign:
Date:
Updated 10.18.13
Research & Academic Volunteer Services
JOB SITE INFORMATION
HELPFUL TIPS FOR FORM COMPLETION
A. COMPLETING & SUBMITTING THE FORM
1. Hosting site completes form, including first two levels of signature approvals (hosting supervisor
and department approval)
2. Hosting department or perspective volunteer submits Job Site Information form and Background
Disclosure Request* together to RAVS via:
a. Email: RAVolunteer@ohsu.edu* OR
b. Fax: 503-494-1099
This completes Step 1* of the registration process
3. RAVS will review and process (approximately 1 week turnaround time – pending background check
results)
4. Once both forms are processed, RAVS will contact perspective volunteer for Step 2* of registration
process
B. ITEMS OF NOTE
1. Volunteers are generally scheduled to volunteer a maximum of 25 hours per week
2. Duties listed on this form are intended to be prompts. Any duties not listed should be clearly
outlined in the “Other” sections provided
3. The Department approval can be an Administrative Coordinator, Department HR Coordinator or
other main department administrative contact; it does not have to be a Department Head or Chair
4. For Supervisor and Department approvals: email approvals instead of formal signatures can be
accepted, but must be attached to the Job Site Information form as one document
5. Volunteers do not need to sign the Job Site Information form until orientation (during Step 2* of
the registration process)
6. For more information about registering your volunteer please visit our website for Hosting
Departments* or frequently asked questions* section on the RAVS website*
*to access embedded web links, please right click the link and select “open hyperlink”
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