Salt Lake County Public Works

Salt Lake County Public Works
COMMUNITY SERVICE APPLICATION
Name*

First NameLast Name
Email*
example@example.com
Please fill in your contact information*
Date of Birth (Must be over the age of 18) *

MonthDayYear
Date
Please list the names, addresses, and phone numbers of two people we may contact in an emergency*
Number of court-appointed hours required:*
Your Probation officer's name and phone number*
Please check each box to the left of each paragraph after you have read it.
Volunteer Agreement 1*

I agree that my services as a Salt Lake County Public Works Operations volunteer are provided on a strictly volunteer basis. I shall receive no pay, benefits, or compensation of any kind from Salt Lake County Public Works Operations for time.
Volunteer Agreement 2*

I agree to volunteer in strict compliance with the policies and procedures of Salt Lake County Public Works Operations.
Volunteer Responsibilities 1*

I understand and agree that I am responsible for maintaining the confidentiality of all appropriate and privileged information.
Volunteer Responsibilities 2*

I understand the Salt Lake County Public Works Operations dress code and will dress appropriately for conditions and duties. This includes wearing appropriate clothing i.e. pants, boots, and appropriate shirt Volunteer expected to wear County provided personal protective equipment PPE as directed by the volunteer coordinator, including but not limited to reflective vest, gloves, hearing protection, and safety glasses.
Volunteer Responsibilities 3*

I understand it is my responsibility to accurately report the hours I volunteer. This needs to be done at the beginning and end of each shift I work.
Indemnity 1*

I agree to release, discharge, indemnify and hold harmless Salt Lake County Public Works Operations, including its agents and employees, for any and all personal injuries or damages to property.
Indemnity 2*

I recognize that using hand and power tools as well as working in the public right-of-way presents a risk of injury including physical harm caused by equipment operation or vehicular traffic. On behalf of myself, my heirs, personal representatives, and executors, I release, discharge, indemnify and hold harmless Salt Lake County Public Works Operations, its agents, volunteers and employees from any and all claims, causes of action or demands, or any nature of cause connected with my volunteer agreement.
Indemnity 3*

I understand that public relations are an important part of volunteering. I agree on behalf of myself, my heirs, personal representatives and executors to allow Salt Lake County Public Works Operations to use any photographs taken of me for use of public relations efforts. Salt Lake County Public Works Operations will use reasonable efforts to notify me but such notification is not a condition of its release for public relations purposes.
Indemnity 4*

I understand that I may refuse to be photographed, and that such refusal shall not change my status as a Salt Lake County Public Works Operations volunteer.
Signature*

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Public Works Volunteer Coordinator: Chris Mowery

Salt Lake County Community Service Contract

If I am accepted as a Salt Lake County Volunteer, I agree to perform the volunteer duties as specified on my selected job description, to the best of my ability and in a professional manner. I will appreciate constructive feedback. If problems arise such as scheduling, I will notify my supervisor as soon as possible before my assigned shift.

Confidentiality:

I agree to maintain the same strict confidentiality regarding my duties that is expected of the paid staff.

Release:

While performing volunteer assignments and duties, the undersigned volunteer (unsalaried worker), authorized by the Division Director and shall be deemed an employee of Salt Lake County only for the purpose of the following liabilities and insurance coverage.
1. Medical benefits under Worker's Compensation for any injury sustained by him/her while engaged in performance of any service.
2. Properly licensed operation of County vehicles or equipment.
3. Liability protection normally afforded salaried employees.
If I, as a Salt Lake County volunteer, will be driving on county business or transporting clients while using my personal vehicle, in the event of a car accident, I shall immediately contact my own insurance carrier. If involved in an accident while on County business I must also file a report with County Risk Management according to Salt Lake County Wide Policy 1011, Accident Reporting. Upon request, the Volunteer Coordinator will provide assistance to complete this report. (Refer to Volunteer Policy #4009 on Volunteer Auto Use)

With this knowledge, the undersigned volunteer hereby releases Salt Lake County, its agents and employees from any liability or obligation arising from, or in connection with, the undersigned's volunteer activities with Salt Lake County other than stated above.
Signature*

Clear

Sexual Harassment and Discrimination Prevention for Volunteers

Harassment is a form of discrimination which is prohibited by federal law and Salt Lake County policy. Discrimination and harassment on the basis of a person's race, color, religion, national origin, sexual orientation, marital staus, or sex is prohibited under County policy. Sexual Harassment is a form of sex

Volunteers - sexual harassment or discrimination is not to be taken lightly. Anyone engaging in conduct prohibited by law could be held personally liable.

Sexual Harassment is defined under Federal Law and County Policy 5730 as: Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual
1. Submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment.
2. Submission to or rejection of such conduct by such individual is used as the basis for employment decisions affecting such individual, or
3. such conduct has the purpose or effect for unreasonably interfering with an individual's work performance or creating an intimidation, hostile, or offensive working environment.
The three elements are:
1. The conduct must be of a sexual nature. This means either words, physical contact, or gestures.
2. The conduct must be unwelcome.
3. A job related factor must be present:
  1. Submission to the unwelcome conduct is a condition of employment.
  2. Submission to the unwelcome sexual activities results in a positive or negative employment decision.
  3. The unwelcome sexual conduct may also interfere with work performance and create a hostile, intimidating or offensive working environment.
In summary, sexual harassment is unwelcome sexual conduct that affects the victim's working conditions.

Preventing harassment- The first line of prevention is to avoid doing or saying anything that might offend someone. The second line of prevention is to report incidents of harassment or discrimination under County Policy. You may report to: any supervisor in your area, the County Mayor, any County Council member, or Utah

Salt Lake County will not tolerate any sexual harassment in the workplace and policy provides for immediate investigation with the appropriate discipline for anyone who engages in harassment.

Read the Salt Lake County Disclosure Statement
If necessary, I have submitted a Statutory Ethical and Disclosure form.
Signature*

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Should be Empty:

Salt Lake County Public Works

COMMUNITY SERVICE APPLICATION

Please check each box to the left of each paragraph after you have read it.

Salt Lake County Community Service Contract

Confidentiality:

Release:

Sexual Harassment and Discrimination Prevention for Volunteers