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Annual Volunteer Evaluation

Hospice Austin is required by our accrediting agency (Community Health Accreditation Program) to provide each volunteer with annual education about privacy rights, infection control, and patient rights. Because this is mandatory, in order to continue as an active Hospice Austin volunteer, we must receive this completed form back from you. Please read and answer the questions below.

Name *
E-mail address *
Remember to honor patients' privacy and keep all information confidential. Don't share information with people you don't know, even if they say they know the patient.

I understand my obligation to patients' privacy under the HIPAA Privacy Rule.
Suspected fraud, abuse, neglect, and exploitation - if you have any suspicions that a patient is being abused, neglected, or exploited by anyone (including a Hospice Austin employee), you must report your suspicions to the volunteer coordinator immediately. If you suspect fraud of any kind, including Medicare billing fraud or identity theft, report that to the volunteer coordinator.

I have reviewed patient rights reminders and understand I must report any suspicions immediately.
Remember to wash your hands for 20-30 seconds before and after patient contact or use hand sanitizing gels containing at least 60% alcohol. If you are sick, protect yourself and your patients and stay home and rest up.

I have reviewed infection control reminders.
For the previous year, I believe I have been a consistent and reliable volunteer.
I submit volunteer time reports for my assignments in a consistent and timely manner. *
I believe I am a good representative of Hospice Austin. *
Additional comments and/or goals for the coming year.
Enter your initials to e-sign this evaluation. *
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