CONTRA COSTA COUNTY

Office of the County Administrator

ADMINISTRATIVE BULLETIN

Number: 421.1

Date: 11-19-96

Section: Personnel

SUBJECT: County Volunteer Programs

I. GENERAL.

This bulletin provides the rules and procedures to be followed by County

departments governing volunteer programs, including the policies and procedures for

reimbursement of expenses; medical and permanent disability benefits; and legal defense

and indemnification against liability claims initiated by third parties. These regulations and

procedures are promulgated in accordance with the policy adopted by the Board of

Supervisors.

II. RULES AND PROCEDURES.

County departments shall submit to the Office of the

County Administrator a description of each volunteer program. Such programs become

County programs subject to the provisions of this Administrative Bulletin upon written

approval of the County Administrator, or designee.

A. County departments sponsoring volunteer programs shall have a staff member

assigned as a volunteer coordinator whose name and telephone number shall be

provided to the County Administrator. The Volunteer Program Coordinator shall be

responsible for the initial orientation and training of new volunteers. Confidentiality

requirements, and program elements shall be explained to volunteers.

B. Volunteers are required to fill out, read and sign an application form and supporting

documents. The volunteer coordinator, or designee, will sign the application form to

acknowledge its receipt and will provide a copy to the applicant

C. Records shall be kept of the acceptance of volunteers. If reimbursement of actual and

necessary expenses in performing volunteer services is authorized, the volunteer must

sign the Oath of Allegiance form. If the volunteer is a minor, the parental consent

form must be completed and signed by the parent or legal guardian.

D. Application, parental consent, auto insurance declaration and oath of allegiance forms

to be used by departments are attached.

E. Disabilities of a volunteer may be discussed with Risk Management and/or the

Affirmative Action Officer.

F. If a volunteer is to use a personal vehicle in the course of authorized volunteer

services, the volunteer will be required to fill out the “Volunteer Auto Insurance

Declaration” form. Volunteers must check with their insurance agent or broker to

make certain that liability insurance is extended under their policy while their vehicle

is being used for volunteer activities. Auto insurance is required for all volunteers

who will use their personal automobile while performing authorized volunteer

services with at least the following limits:

$15,000 for injury to or death to one person

$30,000 for injury to or death to two or more persons in one accident

$ 5,000 for property damage

The volunteer must furnish a California motor vehicle operators license if he/she is to

use a vehicle and the license number together with insurance policy number duly

noted on the Auto Insurance Declaration (form attached). A Certification of

Insurance or other evidence of insurance may be requested and placed on file.

III. INJURY TO VOLUNTEER.

Authorized volunteers are not entitled to workers’

compensation benefits. In lieu thereof and in return for the volunteer waiver of any claim

against the County for illness, injury or other harm arising from acts or occurrences while

providing volunteer services, the County shall provide, in the case of volunteer illness,

injury or death resulting from acts or occurrences while providing authorized volunteer

services, through self-insurance, for reimbursement of County authorized necessary

medical expenses, and for minimum permanent disability compensation equal to that

afforded under the workers’ compensation laws of California, provided, however, that no

temporary disability compensation shall be paid; that medical expenses shall be limited to

reimbursement for expenditures otherwise qualified for reimbursement which are not

covered by the volunteer’s health plan, other available insurance coverage, or other third

party (i.e., Federal, State or other payment); and that the County may elect to have the

County’s Health Services Department provide the volunteer’s necessary medical care.

IV. PUBLIC LIABILITY.

The County through its self-insurance program shall defend and

indemnify volunteers upon request against liability claims initiated by third parties arising

out of the volunteer’s acts or omissions occurring within the scope of authorized volunteer

services, unless the volunteer acted or failed to act because of actual malice, fraud,

corruption or gross negligence. Volunteers using personal automobiles in performing

authorized services must maintain liability insurance at limits which as a minimum comply

with the California Financial Responsibility Law and must have a driver’s license. The

protection afforded by the County shall be in excess only of any other public liability or

automobile liability insurance maintained by or which provides coverage for the volunteer,

and shall not cover any damages to the volunteer’s vehicle including any deductible

amount. Volunteers may be permitted to operate County vehicles in the performance of

authorized volunteer services.

V. PROCUDURE IN CASE OF ACCIDENT OR INJURY.

When a volunteer is injured

while performing authorized volunteer services, the department shall immediately notify

the Risk Management Department and arrange for medical care as necessary. The

volunteer’s supervisor shall immediately thereafter complete the Supervisor’s Report of

Occupational Injuries or Illness (Form AK-30). The Supervisor shall then forward the

form to the volunteer coordinator who within 24 hours shall submit the report through

department channels to Risk Management Division. The form shall indicate that the

injured party is a volunteer and identify any referral to a medical provider. The Risk

Management Division may arrange for the County’s Health Services Department to

provide the volunteer’s medical care.

All medical bills received by the volunteer for County authorized medical care not

otherwise covered by health insurance, other insurance, or third party payment shall be

forwarded to the Office of the County Administrator, Risk Management Division. Such

bills must be itemized and indicate the date of injury. County payments will be made

jointly to the volunteer and to the medical provider.

Any claims for permanent disability compensation shall be referred to the Risk

management Division for review and adjustment. Prior to final settlement and payment for

any such claim, the volunteer shall execute an appropriate form releasing the county from

any further liability and agreeing that such compensation shall be the volunteer’s sole and

exclusive remedy with respect to the injury sustained.

When there is an accident resulting in third party personal injury or property damage, the

appropriate accident report form shall be completed by the Supervisor and forwarded to the

volunteer coordinator and to the Risk Manager Division. The subsequent procedure to be

followed shall be identical to that applicable as in accidents involving County employees.

IV. REIMBURSEMENT OF EXPENSES.

Volunteers are eligible to receive reimbursement

from the County for certain actual and necessary expenses incurred in the performance of

authorized volunteer services. In order to claim expenses, the volunteer must have signed

the Oath of Allegiance before any County officer authorized to administer oaths and meet

previously described insurance requirements.

Volunteers are subject to the County reimbursement policies established for County

employees. The County will not reimburse volunteers for child care expenses; mileage

from the volunteer’s residence to the County designated facility or service location, unless

authorized and funded by a federally-funded or state-funded program approved by the

Board of Supervisors; or damage to the volunteer’s personal vehicle, including any

deductible provisions which are paid by the volunteer. The volunteer must provide

information to the volunteer coordinator with respect to the automobile liability insurance

coverage maintained prior to the use of the personal vehicle for volunteer services and

reimbursement of mileage claims.

NOTE: Forms can be reproduced locally.

Orig. dept.: County Administrator

/s/

____________________________

Phil Batchelor,

County Administrator

CONTRA COSTA COUNTY

VOLUNTEER APPLICATION AND REGISTRATION FORM

________________________________________________________________/_______/_____

Name Age Social Security No.

______________________________________________________________________________

Home Address Home Phone

______________________________________________________________________________

Business Address Business Phone

______________________________________________________________________________

Driver’s License No., If Any

Do you have a health problem we should be aware of in an emergency?

Yes____ No____ (Describe: such as a history of back trouble, heart, epilepsy, diabetes,

fainting, etc.)___________________________________________________________________

______________________________________________________________________________

Is there a medication you must take? Yes____ No____

Is there a medication to which you are allergic? Yes____ No____

If yes, medication is:_____________________________________________________________

______________________________________________________________________________

Medical or Hospital Insurance Plan:_________________________________________________

Automobile Insurance Carrier:_____________________________________________________

______________________________________________________________________________

Person to Call in Emergency Address Phone No.

I have been informed against and accept responsibility for any breach on my part respecting

confidential information. I have read the Policy adopted by the Contra Costa County Board of

Supervisors on volunteer programs. In return for the benefits provided by Contra Costa County

in case of my illness, injury, death, or third party liability while providing, or resulting from acts

or occurrences within the scope of my authorized volunteer services, and for my right to

authorized expense reimbursement, I waive any claim on my behalf and on behalf of my heirs,

representatives, and assigns against the County of Contra Costa any other agency governed by

the Board of Supervisors, and any agent, officer or employee thereof for illness, injury, debts or

without limitation, other harm arising from my volunteer services, whether or not authorized.

______________________________________________________________________________

Signature Date

Received:______________________________________________________________________

Signature Date

CONTRA COSTA COUNTY

PARENTAL CONSENT FORM

VOLUNTEER PROGRAM

Name of Minor: _______________________________________________________________

Address: _______________________________________________________________

_______________________________________________________________

Birth Date: _______________________________________________________________

Volunteer Activity: ____________________________________________________________

The above person, a minor, desires to perform volunteer services for the County in accordance

with the attached application form.

As parent/guardian of this minor, permission is hereby granted for him/her to participate in the

volunteer program. My child does not have any physical or medical problems which would

prohibit or limit participation in the volunteer program, except:

______________________________________________________________________________

In case of illness or emergency, please call: __________________________________________

______________________________________________________________________________

Telephone Number:_____________________________________________________________

I have reviewed the volunteer application and registration form and the policy adopted by the

Contra Costa County Board of Supervisors on volunteer programs, and give my consent for ____

_____________________ to participate in the volunteer program subject to the terms and

conditions expressed therein.

Signed by Parent/Guardian: _______________________________________________________

Date: __________________

CONTRA COSTA COUNTY

VOLUNTEER SERVICES

AUTO INSURANCE DECLARATION

Date: ___________________________

This is to certify that I, the undersigned, am in possession of a valid California Driver’s License:

No.:_____________________________ Expiration Date:______________________

My car is a:

Make: ________________________ Model: __________________________

Year: ________________________ License No.: _______________________

My car is insured with:

Company: ____________________________________________________________________

Policy No.: ___________________________________________________________________

Expiration Date: _______________________________________________________________

I further certify that I have minimum liability insurance coverage as follows:

$15,000 for injury to, or death of, one person;

$30,000 for injury to, or death of, two or more persons in one accident;

$ 5,000 for property damage.

If I no longer meet the minimum liability insurance coverage requirements, I will immediately

notify the Volunteer Program Coordinator.

____ I certify that I will not be operating a vehicle in my capacity as a volunteer.

________________________________

Signature

________________________________

Address

________________________________

CONTRA COSTA COUNTY

Martinez, California

VOLUNTEER PROGRAM POLICY

The use of volunteers in performing specific services is a valuable resource and provides an

avenue for citizen participation in various County programs which is recognized as being of

public benefit. In recognition of the benefits which may be derived from volunteer services, it is

hereby declared that it shall be County policy to encourage and promote volunteer programs

determined to be in the public interest.

It is County policy that volunteers will not replace County employees but will provide services to

supplement or enrich regular County programs and services.

This policy statement is designed to provide the framework for County volunteer programs

activities. The following guidelines are adopted for volunteer programs.

A. Volunteer Programs

A description of each volunteer program shall be submitted by the department head to the

County Administrator for review and approval.

Factors to be considered in evaluating programs are the need for and public benefit to be

derived from the volunteer program, associated County cost and staff effort required for

such a program, the potential for injury to volunteers, and the possibility for injury to others

including injuries giving rise to possible liability claims.

The County Administrator may adopt regulations governing the administration of this

volunteer program.

B. Volunteers

A volunteer is defined as a person who renders services gratuitously and has been accepted

in the volunteer program. The volunteer is not an employee of the County.

In recognition of the benefit to the County derived from volunteer services, and in return

for their waiver on their own behalf and on behalf of their heirs, representatives, and

assigns of any claim against the County of Contra Costa, other agency governed by the

Board of Supervisors, and any agent, officers, or employee thereof, for illness, injury,

debts, or without limitation any other harm arising from such volunteer services, authorized

volunteers serving in approved programs shall be provided the benefits indicated below:

1. Injury to Volunteer.

Contra Costa County volunteers are not entitled to workers’

compensation benefits. In lieu thereof and in return for the volunteer’s waiver of any

claim against the County for illness, injury or other harm arising from acts or

occurrences while providing volunteer services, the County shall provide, in the case

of volunteer illness, injury or death resulting from acts or occurrences while

providing authorized volunteer services, through self-insurance, for reimbursement of

County authorized necessary medical expenses, and for minimum permanent

disability compensation equal to that afforded under the workers’ compensation laws

of California, provided, however, that no temporary disability compensation shall be

paid; that medical expenses shall be limited to reimbursement for expenditures

otherwise qualified for reimbursement which are not covered by the volunteer’s

health plan, other available insurance coverage, or other third party (i.e., Federal,

State or other payment); and that the County may elect to have the County’s Health

Service Department provide the volunteer’s necessary medical care.

2. Public Liability.

The County through its self-insurance program shall defend and

indemnify volunteers upon request against liability claims initiated by third parties

arising out of the volunteer’s acts or omissions occurring within the scope of

authorized volunteer service, unless the volunteer acted or failed to act because of

actual malice, fraud, corruption or gross negligence. Volunteers may be permitted to

operate County vehicles in the performance of authorized volunteer services.

Volunteers using County or personal automobiles in performing authorized services

must maintain liability insurance at limits which as a minimum comply with the

California Financial Responsibility Law and must have a driver’s license. The

protection afforded by the County shall be in excess only of any other public liability

or automobile insurance maintained by or which provides coverage for the volunteer,

and shall not cover any damages to the volunteer’s vehicle, including any deductible

amount.

3. Expense Reimbursement.

Volunteers may be reimbursed for actual and necessary

expenses in performance of authorized volunteer services at the same rates and in

accordance with regulations and procedures established for County employees. No

reimbursement will be made for any child care expenses, mileage from the personal

residence of the volunteer to the County facility or service location or for damage to

personal vehicles or other property of volunteers used when performing authorized

volunteer services.