GoodSAM

Volunteer Responders referral and Steward Volunteer request form

This form is for:

Requesting Steward Volunteers for COVID-19 vaccination sites
Referring individuals, NHS or social care organisations for support from volunteers. The types of support are listed below.

When you submit your first request you will receive an emailed verification link. Once you have clicked this link you will automatically be registered and your requests for support will be live in the GoodSAM app. This means the app will allocate the tasks to available volunteers in relevant locations. All of your further referrals will be live immediately. You will have access to a dashboard which shows whether the requests/referrals you have entered have been matched with volunteers.

Full details of the referral process and instructions are in the Guidance for Referrers. This also includes information regarding your responsibilities and those of Royal Voluntary Service in relation to Steward Volunteers.

Other ways to request volunteers are:

By phone on 0808 196 3382.
Asking patients to self-refer on 0808 196 3646. Further details are here.

Please note that we will process personal data in accordance with our Privacy Notice - Referral Parties, which you can find here.

Local authority area *

I am a referrer that represents: *

Support Required *

You must select the correct support as this is matched to a volunteer with specific vetting for that role. IF YOU ARE UNSURE PLEASE CALL 0808 196 3382.

Check in and Chat Support: A person requires a telephone chat and some encouragement to reduce loneliness and improve their wellbeing (these will be from a number of different volunteers). Check in and Chat Plus Support: A vulnerable person requires regular telephone calls and encouragement to reduce loneliness and improve their wellbeing and these should be from the same volunteer. (3 calls per week for 6 weeks from a volunteer.) COVID Vaccination Steward Support: Volunteers will support the safe movement of patients around vaccination sites. They can monitor patient numbers, ensure safe social distancing, and identify patients who may need additional support. The maximum shift length is 4 hours. Community Response: Provide support to a person on a one-off basis or for a period of 6 weeks, days and times to be agreed between the volunteer and the person supported. Support includes the collection and delivery of food shopping and essential items and / or prescriptions and medications to people waiting to be admitted to hospital or those who have just been discharged. The support is also available to carers and to people with health conditions where there is a current health need. Pick Up and Deliver: Volunteers transport medicine or small items of medical equipment to people's homes from NHS sites. This activity supports people who have been newly discharged from hospital to home, are waiting for admission to hospital or are being cared for on a virtual ward. No biological specimens can be delivered.

Site type *

Lead Contact Name

Person's Date Of Birth *

Do the patient(s) have suspected or confirmed COVID 19 (High Risk) *

Person's letter format *

Person's preferred language *

Patient's Name

If you would like to be notified by text if a match is not made then please supply a mobile number

Is this a return journey? *

Time when you need the volunteers until *

Number of volunteers required *

The volunteer can make up to four deliveries. If you need more than this, please select number of volunteers.

Additional information *

Please use the text box below to relay essential information to volunteers in the format suggested.

Please note that Steward Volunteers cannot assist with any clinical or administrative/clerical duties.

You have selected ongoing support. This means the person will receive support once a week for 6 weeks. If the support you require is one-off then please select no.

Please note that support will only be provided for a maximum of 6 weeks, after this duration you will need to place a new referral.

Your details

First Name *

Last Name *

Email *

(You will receive an email verification link after your first referral, once you have confirmed this, you will receive your login details - Requests from NHS/Gov email addresses will then go live automatically, alternative addresses will need approval and may take up to 72 hours)

Contact Number *

Your Organisation's
Name *

Your Organisation's
Postcode *

Where did you hear about us? *

I confirm that the person or organisation is aware of this referral and that I have permission from them to refer for support and for Royal Voluntary Service to use the information included in this form (including information about their health and, in instances of support with prescriptions, their medication(s), doses and treatment regime) for the purposes of providing support to them through the Volunteer Responder Scheme.

YOU ARE ABOUT TO REQUEST A VOLUNTEER - THIS IS NOT A REGISTRATION FORM.

Service provided by:

Sectors: Medical | Police | Fire and Rescue | Third sector