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The City of Bainbridge Island (“City”) recognizes the important contributions community volunteers make in the aftermath of a disaster. The City’s Emergency Management (EM) Program offers a number of volunteer positions for residents who are interested in becoming part of the City’s disaster response plan.

This form is the first step in the City’s EM volunteer review and assessment process. All potential volunteers will complete a background investigation, be screened, and be matched to positions according to their skills and abilities in order to best serve and protect residents and current volunteers. The City reserves the right to deny volunteer service. The data furnished on this form is provided on a voluntary basis and will be used to contact, interview, and place volunteers.

Notices:

Personal Injury and Reporting: Volunteers are not considered to be City employees. Injury compensation is provided through the Washington State Department of Labor & Industries. All Volunteers are required to sign in and sign out at all sponsored events, trainings, and exercises. Official sign in sheets will be submitted on your behalf by the City Emergency Manager in order to comply with state requirements.

Volunteer Limitations: Volunteers must stay within their respective team's Scope of Work. Activities performed outside or in excess of the volunteer’s Scope of Work will be considered unauthorized and may lead to termination.

Provision of Personal Protective Equipment (PPE): The City will provide PPE as required for the Scope of Work and identified by the Washington Industrial Safety and Health Act. All volunteers requiring PPE will be provided adequate training in its proper care and use. Volunteers are responsible for supplying basic PPE per City of Bainbridge Island Volunteer/Emergency Worker Code of Conduct.

Use of Personal Vehicles/Mileage Reimbursement: The City will reimburse for mileage for volunteers who routinely drive a personal vehicle as part of their volunteer duties, not to include mileage from the home of residence to City Hall or other meeting locations. A valid driver’s license issued within the United States and personal automobile insurance are required for expenses to be reimbursed. This policy also includes fuel reimbursement for marine vessels, provided that a Captain’s license, if applicable, and the insurance provisions above are met. Reimbursement is based on the IRS Mileage Rate at the time of travel. Volunteers must submit a completed City Travel Reimbursement form to be reimbursed. Emergency Management Volunteers are not authorized to drive City vehicles.

Termination: The City and/or the volunteer may terminate this service at any time without cause. The termination will be effective immediately upon the provision of written notice.
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First Name *
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For example, 123-456-7890
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A valid date as MM/DD/YYYY (for example: 11/30/2015)
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Telephone Number *
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Please indicate which volunteer position you would like to apply for:























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Criminal History Authorization Form - Emergency Volunteer
Click here to complete the background check online!

If you would like the City of Bainbridge to run your background check, please complete page 6 in this document
COBI EM Volunteer Program Application

I hereby give permission for the City of Bainbridge Island Department of Emergency Management to conduct a Criminal History background investigation, and also obtain an abstract of my driving record if needed.

SIGNATURE: ___________________________________ DATE: ________________
Please enter your name to serve as a digital signature to agree to the criminal, history authorization (background check) *
Personal Responsibilities of Emergency Workers (WAC 118.04.200) Immunity from Liability for Covered Volunteer Workers (RCW 38.52.180) and COBI Volunteer/ Emergency Worker Code of Conduct
Personal Responsibilities of Emergency Workers (WAC 118.04.200)

(1) Emergency workers shall be responsible to certify to the authorized officials registering them and using their services that they are aware of and will comply with all applicable responsibilities and requirements set forth in these rules.
(a) Emergency workers have the responsibility to notify the on-scene authorized official if they have been using any medical prescription or other drug that has the potential to render them impaired, unfit, or unable to carry out their emergency assignment.
(b) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of or while using narcotics or any illegal controlled substance is prohibited.
(c) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of alcohol is prohibited.
(d) Emergency workers participating in any mission, training event, or other authorized activity shall possess a valid operator's license if they are assigned to operate vehicles, vessels, or aircraft during the mission unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180. All emergency workers driving vehicles to or from a mission must possess a valid driver's license and required insurance.
(e) Use of private vehicles, vessels, boats, or aircraft by emergency workers in any mission, training event, or other authorized activity without liability insurance required by chapter 46.29 RCW is prohibited unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180.
(f) Emergency workers shall adhere to all applicable traffic regulations during any mission, training event, or other authorized activity. This provision does not apply to individuals who have completed the emergency vehicle operator course or the emergency vehicle accident prevention course and who are duly authorized under state law to use special driving skills and equipment and who do so at the direction of an authorized official.
(2) Emergency workers have the responsibility to comply with all other requirements as determined by the authorized official using their services.
(3) When reporting to the scene, emergency workers have the responsibility to inform the on-scene authorized official whether they are mentally and physically fit for their assigned duties. Emergency workers reporting as not fit for currently assigned duties may request a less demanding assignment that is appropriate to their current capabilities.
(4) Emergency workers have the responsibility to check in with the appropriate on-scene official and to complete all required recordkeeping and reporting.

Immunity from Liability for Covered Volunteer Workers (RCW 38.52.180)

(1) There shall be no liability on the part of anyone including any person, partnership, corporation, the state of Washington or any political subdivision thereof who owns or maintains any building or premises which have been designated by a local organization for emergency management as a shelter from destructive operations or attacks by enemies of the United States for any injuries sustained by any person while in or upon said building or premises, as a result of the condition of said building or premises or as a result of any act or omission, or in any way arising from the designation of such premises as a shelter, when such person has entered or gone upon or into said building or premises for the purpose of seeking refuge therein during destructive operations or attacks by enemies of the United States or during tests ordered by lawful authority, except for an act of willful negligence by such owner or occupant or his or her servants, agents, or employees.
(2) All legal liability for damage to property or injury or death to persons (except an emergency worker, regularly enrolled and acting as such), caused by acts done or attempted during or while traveling to or from an emergency or disaster, search and rescue, or training or exercise authorized by the department in preparation for an emergency or disaster or search and rescue, under the color of this chapter in a bona fide attempt to comply therewith, except as provided in subsections (3), (4), and (5) of this section regarding covered volunteer emergency workers, shall be the obligation of the state of Washington. Suits may be instituted and maintained against the state for the enforcement of such liability, or for the indemnification of persons appointed and regularly enrolled as emergency workers while actually engaged in emergency management duties, or as members of any agency of the state or political subdivision thereof engaged in emergency management activity, or their dependents, for damage done to their private property, or for any judgment against them for acts done in good faith in compliance with this chapter: PROVIDED, That the foregoing shall not be construed to result in indemnification in any case of willful misconduct, gross negligence, or bad faith on the part of any agent of emergency management: PROVIDED, That should the United States or any agency thereof, in accordance with any federal statute, rule, or regulation, provide for the payment of damages to property and/or for death or injury as provided for in this section, then and in that event there shall be no liability or obligation whatsoever upon the part of the state of Washington for any such damage, death, or injury for which the United States government assumes liability.
(3) No act or omission by a covered volunteer emergency worker while engaged in a covered activity shall impose any liability for civil damages resulting from such an act or omission upon:
(a) The covered volunteer emergency worker;
(b) The supervisor or supervisors of the covered volunteer emergency worker;
(c) Any facility or their officers or employees;
(d) The employer of the covered volunteer emergency worker;
(e) The owner of the property or vehicle where the act or omission may have occurred during the covered activity;
(f) Any local organization that registered the covered volunteer emergency worker;
(g) The state or any state or local governmental entity; and
(h) Any professional or trade association of covered volunteer emergency workers.
(4) The immunity in subsection (3) of this section applies only when the covered volunteer emergency worker was engaged in a covered activity:
(a) Within the scope of his or her assigned duties;
(b) Under the direction of a local emergency management organization or the department, or a local law enforcement agency for search and rescue; and
(c) The act or omission does not constitute gross negligence or willful or wanton misconduct.
(5) For purposes of this section:
(a) "Covered volunteer emergency worker" means an emergency worker as defined in RCW 38.52.010 who (i) is not receiving or expecting compensation as an emergency worker from the state or local government, or (ii) is not a state or local government employee unless on leave without pay status.
(b) "Covered activity" means:
(i) Providing assistance or transportation authorized by the department during an emergency or disaster or search and rescue as defined in RCW 38.52.010, whether such assistance or transportation is provided at the scene of the emergency or disaster or search and rescue, at an alternative care site, at a hospital, or while in route to or from such sites or between sites; or
(ii) Participating in training or exercise authorized by the department in preparation for an emergency or disaster or search and rescue.
(6) Any requirement for a license to practice any professional, mechanical, or other skill shall not apply to any authorized emergency worker who shall, in the course of performing his or her duties as such, practice such professional, mechanical, or other skill during an emergency described in this chapter.
(7) The provisions of this section shall not affect the right of any person to receive benefits to which he or she would otherwise be entitled under this chapter, or under the workers' compensation law, or under any pension or retirement law, nor the right of any such person to receive any benefits or compensation under any act of congress.
(8) Any act or omission by a covered volunteer emergency worker while engaged in a covered activity using an off-road vehicle, nonhighway vehicle, or wheeled all-terrain vehicle does not impose any liability for civil damages resulting from such an act or omission upon the covered volunteer emergency worker or the worker's sponsoring organization.

City of Bainbridge Island

City of Bainbridge Island Volunteer/Emergency Worker Code of Conduct

Volunteers are expected to act responsibly and to treat all other volunteers, community members, and emergency response personnel with respect.

Volunteers are expected to follow the code of conduct outlined below:
1. Volunteers will not use their position for their own personal benefit.
2. Volunteers will not seek or accept any financial advantage or gain that may be offered as a result of the volunteer’s affiliation with the City. Any known or potential conflicts of interest must be disclosed to the City’s Emergency Manager within seven days.
3. Volunteers will not publicly utilize any City affiliation in connection with the promotion of partisan politics or religious matters.
4. Volunteers will not disclose any confidential information that is available solely as a result of their service, to any person not authorized to receive such information, or use to the disadvantage of the City any such confidential information, without the express authorization of the City.
5. Volunteers will not knowingly take any action or make any statement intended to influence the conduct of the Volunteer Group in such a way as to confer any financial benefit on any person, corporation, or entity in which the individual has significant interest or affiliation.
6. Volunteers will operate and/or act only in a manner that is in the best interests of the City.
7. Volunteers will not engage in any inappropriate behavior that would jeopardize the program’s effectiveness and sustainability, to include: profane language, public criticism of a team member, or purposefully jeopardizing the safety of the public or a team member.
8. Volunteers do not have a legal duty to act and are not required to respond to incidents in the immediate area, nor to recall requests. Once responded, however, volunteers must follow safe and effective practices at all times. Volunteers who abandon their duty assignment, act outside of their training or Scope of Work, or otherwise violate policies or this Code of Conduct are subject to termination.
9. Volunteers will not self-deploy to any emergency response or event, except in the case of a catastrophic earthquake in which you have been given a pre-assigned reporting location (Disaster Hub, Family Reunification Center, Disaster Medical Center, etc.)
10. Volunteers will report all unsafe situations, activities or practices immediately and take appropriate protective action for themselves and bystanders.
11. Volunteers will bring or wear appropriate Personal Protective Equipment (PPE): hard hat, vest, dust mask, goggles, gloves (latex and/or leather), sturdy shoes, long pants, flashlight, bottled water, food, etc. Shorts, sandals, and open-toed shoes are strictly prohibited when responding to an incident and/or training event. If scope of work requires certain PPE, the City will provide it.
12. Volunteers will limit their actions to their physical and resource abilities as determined by, but are not limited to, equipment availability, physical abilities, knowledge, authority, and hazards.

Application updated 02/24/2025

Disclaimer

VOLUNTEER AFFIRMATION
I, _________________________________________, hereby volunteer my services for the City of Bainbridge Island's Emergency Management Program in accordance with the attached Scope of Work. I understand I will not be compensated for my work. Further, I hereby certify that I am capable of performing the duties outlined in the attached Scope of Work __with or __ without the accommodation(s) listed.

List of accommodations: ________________________________________________________________________________________________________

In consideration of giving me permission to perform these volunteer services, I agree to the following terms:
1. I will not appear for volunteer service under the influence of any drugs or alcohol.
2. If after being accepted as a volunteer with the City's Emergency Management Plan, I am arrested for or charged with any criminal offense, I will report my arrest or charge within seven (7) days of my arrest or the filing of any criminal charge.
3. I will abide by the City's Emergency Worker/Volunteer Code of Conduct (attached).
4. I agree not to exceed the Scope of Work for my volunteer position without prior authorization from the City's Emergency Management Coordinator or on-scene City or Fire District official in charge.
5. Should I be injured while performing authorized volunteer work, I understand that the City has included my hours of volunteer service in the Washington State Department of Labor and Industries coverage for volunteer workers.
6. I will report any on-the-job injury or illness, no matter how minor, to the City's Human Resources Staff.
7. I consent to the City performing a criminal history background check in accordance with RCW 43.43.830-839 and waive any right of privacy I may have in such information for the limited purpose of considering it for determining my suitability as a volunteer. Further, I release the City of Bainbridge Island and those individuals/institutions that provide information from any liability that may arise from the provision of this information.
8. The City may terminate this agreement at any time without cause. I am volunteering my services at will and may be asked to discontinue such without prior notice or reason.
9. I am fully aware that the work associated with being a volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the Emergency Management Volunteer Program, I hereby assume all risk of injury, damage, and harm to myself arising from such activities. I also hereby individually and on behalf of my heirs, executors, and assignees, release and hold harmless the City, its officials, employees, and agents and waive any right of recovery that I might have to bring a claim or lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities, except for those caused by the sole negligence of the City of Bainbridge Island.
10. I authorize any necessary emergency medical treatment that might be required for me in the event of physical injury and/or accident to me while participating in this program.
11. I have read, understand, and agree to abide by the Personal Responsibilities of an Emergency Worker (WAC 118.04.200) (attached).
12. I have read and understand the Immunity from Liability for Covered Volunteer Workers (RCW 38.52.180) (attached).
13. I give permission for photos/videos taken of myself during volunteer activities to be used for publicity purposes without recompense.
Application updated 2/1/2021
14. This agreement will be in effect for the duration of my volunteer services.
Signature: ___________________________________________
Printed Name: _______________________________________
Dated this__________ day of___________, 20_____.

VOLUNTEER AFFIRMATION
I, _________________________________________, hereby volunteer my services for the City of Bainbridge Island's Emergency Management Program in accordance with the attached Scope of Work. I understand I will not be compensated for my work. Further, I hereby certify that I am capable of performing the duties outlined in the attached Scope of Work __with or __ without the accommodation(s) listed.

List of accommodations: ________________________________________________________________________________________________________

In consideration of giving me permission to perform these volunteer services, I agree to the following terms:
1. I will not appear for volunteer service under the influence of any drugs or alcohol.
2. If after being accepted as a volunteer with the City's Emergency Management Plan, I am arrested for or charged with any criminal offense, I will report my arrest or charge within seven (7) days of my arrest or the filing of any criminal charge.
3. I will abide by the City's Emergency Worker/Volunteer Code of Conduct (attached).
4. I agree not to exceed the Scope of Work for my volunteer position without prior authorization from the City's Emergency Management Coordinator or on-scene City or Fire District official in charge.
5. Should I be injured while performing authorized volunteer work, I understand that the City has included my hours of volunteer service in the Washington State Department of Labor and Industries coverage for volunteer workers.
6. I will report any on-the-job injury or illness, no matter how minor, to the City's Human Resources Staff.
7. I consent to the City performing a criminal history background check in accordance with RCW 43.43.830-839 and waive any right of privacy I may have in such information for the limited purpose of considering it for determining my suitability as a volunteer. Further, I release the City of Bainbridge Island and those individuals/institutions that provide information from any liability that may arise from the provision of this information.
8. The City may terminate this agreement at any time without cause. I am volunteering my services at will and may be asked to discontinue such without prior notice or reason.
9. I am fully aware that the work associated with being a volunteer involves certain risks of physical injury or death. Being fully informed as to these risks and in consideration of my being allowed to participate in the Emergency Management Volunteer Program, I hereby assume all risk of injury, damage, and harm to myself arising from such activities. I also hereby individually and on behalf of my heirs, executors, and assignees, release and hold harmless the City, its officials, employees, and agents and waive any right of recovery that I might have to bring a claim or lawsuit against them for any personal injury, death or other consequences occurring to me arising out of my volunteer activities, except for those caused by the sole negligence of the City of Bainbridge Island.
10. I authorize any necessary emergency medical treatment that might be required for me in the event of physical injury and/or accident to me while participating in this program.
11. I have read, understand, and agree to abide by the Personal Responsibilities of an Emergency Worker (WAC 118.04.200) (attached).
12. I have read and understand the Immunity from Liability for Covered Volunteer Workers (RCW 38.52.180) (attached).
13. I give permission for photos/videos taken of myself during volunteer activities to be used for publicity purposes without recompense.
Application updated 2/1/2021
14. This agreement will be in effect for the duration of my volunteer services.
Signature: ___________________________________________
Printed Name: _______________________________________
Dated this__________ day of___________, 20_____. Please check this box to confirm you have read and agree to the VOLUNTEER AFFIRMAITON above.

PO Box 11402
Bainbridge Island, WA 98110
Office: (206) 659-6946
info@bainbridgeprepares.org

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