The COVID-19 Community Vaccination Sites are events of the City of Seattle in coordination with Swedish Health Services dba Swedish Medical Group (Swedish), Virginia Mason Franciscan Health and Seattle Center Foundation. Thank you for participating. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver as a condition of participating in the events.
By signing below, I, the undersigned volunteer, agree to provide services to the Vaccination Sites as a volunteer. As a condition of volunteering, I agree as follows:
For All Volunteers
1. I am donating my services (“Vaccination Sites Services”). City of Seattle, Swedish, and Virginia Mason will follow the pay practices of their respective organizations. Unless otherwise stated, I acknowledge that I am not entitled to any present or future salary or wages for providing Vaccination Sites Services, and no one has made any promises to me regarding future employment or any other payments.
2. I am eighteen years of age or older.
3. I understand I may be exposed to blood, bodily fluids and other potentially infectious materials that may contribute to the risk of acquiring HIV, Hepatitis B, COVID-19 or other diseases. If I am exposed, or if there is a circumstance where I am the source of an exposure, I will immediately report the incident to Vaccination Site officials. I understand if I am exposed, that I may be responsible for the cost of all subsequent tests, treatments and medical care.
4. I knowingly assume the risk of participating as a volunteer for the Vaccination Sites. In consideration of participating as a volunteer for the Vaccination Sites, I, for myself, my spouse, my legal representatives, heirs, and assigns, hereby forever unconditionally waive all claims (in law, equity, or otherwise) against the City of Seattle, Swedish, Virginia Mason Franciscan Health, Seattle Center Foundation, Amazon, Neighborhood House and their respective subsidiaries, affiliates, officers, trustees, officials, employees, and agents, and volunteers, (collectively, "Vaccination Sites Parties"), arising out of my participation in the Vaccination Sites and my provision of Vaccination Sites Services. This Agreement does not constitute a waiver of benefits or burdens that may be applicable under the Washington Industrial Insurance Act (RCW Title 51).
5. I agree that I will not take any action, or omit taking any action, the result of which act or omission could be to waive the City’s immunity from liability under the PREP Act.
6. I also grant the City of Seattle and their respective agents the right to use, without payment or consideration of any kind, my picture, voice, and other reproductions of my physical likeness in connection with advertising or publicizing Vaccination Sites Services and activities in all forms of media in perpetuity.
7. I agree to notify Vaccination Site officials immediately if I am injured or if I become aware of any accident or injury to another volunteer or clinic participant.
8. I understand that Vaccination Site officials maintain the right to revoke my participation at any time with or without cause.
9. Volunteer positions may require a Washington State Patrol background check to volunteer for Vaccination Sites Services. I will either agree to the background check or I may decline to participate.
10. Volunteer positions require proof of being fully vaccinated for COVID-19 to volunteer for Vaccination Sites Services. I will either agree to provide this proof of vaccination or I may decline to participate.
For All Volunteers Accessing Confidential Information
In compliance with the federal and state privacy laws, I agree to hold in confidence all personal and protected health information I may overhear or come in contact with during and following the performance of Vaccination Sites Services. I further agree not to access, or remove from the premises, personal and protected health information or records unless relating to my performance of Vaccination Sites Services. It is understood that I shall be responsible for any direct or consequential damages resulting from my violation of this requirement.
As a condition of and in consideration of my use, access, and/or disclosure of confidential information, I understand and agree to the confidentiality requirements outlined in this Agreement. I understand that these requirements and my responsibility to protect the confidentiality and security of information apply when I am working off-site as well as at any owned and/or operated sites.
Confidential information may include, but is not limited to:
• Patient information (medical records, conversations, demographic information, financial information).
• Employee information (salaries, employment & payroll records, unlisted phone numbers, health records).
• Proprietary information (financial reports, production reports, report cards, reimbursement tables and contracted rates, strategic plans, internal reports, memos, contracts, peer review information, credit information, communications, computer programs, technology).
• Third party information (computer programs, vendor information, technology).
I will access, use and disclose minimum confidential information only as necessary to perform my role.
This means, among other things, that:
A. I will only access, use, and disclose the minimum confidential information as authorized to do this role;
B. I will not in any way access, use, divulge, copy, release, sell, loan, review, alter, or destroy any confidential information except as properly and clearly authorized within the scope of my role and in accordance with all applicable laws;
C. I will report to my shift supervisor or lead any individual’s or entity’s activities that I suspect may compromise confidential information.
Because all of my passwords (and/or other authentication devices such as tokens or cards) are the equivalent of my signature and because I am the only person authorized to use them, I agree to the following:
A. I will safeguard and not disclose my passwords or allow the use of my authentication devices by anyone including my manager or supervisor or another volunteer or staff member.
B. I will not request access to or use any other person’s passwords or authentication devices.
C. I accept responsibility to log out of the system to which I’m logged on. I will not under any circumstances leave unattended a computer to which I have logged on without first either locking it or logging off the workstation.
D. If I have reason to believe that the confidentiality of my password has been compromised, I will immediately change my password.
E. I understand that my password/or access will be deactivated in the event my role no longer requires use of the computerized system.
F. I understand that the Vaccination Sites have the right to conduct and maintain an audit trail of all access to patient information and other system activity such as internet access and the Vaccination Sites may conduct a review to monitor appropriate use of my system activity at any time and without notice.
G. I understand and accept that I have no individual rights to or ownership interests in any confidential information referred to in this agreement and that therefore the Vaccination Sites may at any time revoke my passwords or access codes.
I understand that it is my responsibility to be aware of these policies specifically addressing the handling of confidential information and that misconduct may result in loss of volunteer privileges.
I understand my obligations under this Agreement will continue indefinitely after leaving my role with the Vaccination Sites.
Special Provisions Applicable to Clinical Providers
If I am a clinical provider, I also agree as follows:
A. I represent that I have all necessary active licenses issued by the appropriate licensing authority which are required in order to provide treatment to patients and that I am not currently subject to any disciplinary action or investigation for criminal or professional misconduct in any jurisdiction.
B. I shall inform Vaccination Site officials if my license or disciplinary status changes.
C. I am responsible for performing the Vaccination Sites Services in a professional manner and in accordance with the standard of care and all applicable laws, rules, and regulations, including, without limitation, receiving a Hepatitis B vaccine.
D. If I am licensed in a United States jurisdiction other than Washington State, I agree to submit an attestation to the Washington State Department of Health at least ten (10) working days in advance of volunteering in Washington State.
E. I am responsible for the standard of care and quality of treatment I provide patients, and I am not subject to the supervision or control of the City of Seattle or the other Vaccination Sites Parties (as defined in 4 above). As a result, I agree that while I am donating my services to the Vaccination Sites, I will not be considered a volunteer under the direction of the City of Seattle or the Vaccination Sites Parties, and I agree that the provisions of Seattle Municipal Code 4.64.100 and .110 do not and shall not apply. I agree to defend, indemnify and hold the Vaccination Sites Parties (as defined in 4 above) harmless from all liability, claims, demands, losses, damages, action or judgments of every kind (including reasonable attorney’s fees) which may occur arising out of my treatment of patients and participation in the Vaccination Sites.
F. Any follow up treatment provided by me to a patient at a different location or after the Vaccination Sites dates is outside the scope of Vaccination Sites Services.
G. My acceptance of this agreement signifies that I give permission to the Vaccination Sites to verify the status of my license, my insurance, my proof of vaccination, and my background.
Provision Applicable to All Volunteers
By signing below, I represent that I am eighteen years of age or older, that I have read this agreement, including the release and waiver of liability, and fully understand its terms, understand that I will give up rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me, and intend my signature to be a complete and unconditional release of all liability.