Esteemed colleagues:  A few weeks ago, I asked you for information on
insurance and liabiity for volunteer workers.  I received ten thoughtful
answers (thanks again!) and am still digesting the information.  One of the
items that arrived is a form that outlines the rights of volunteers, and
the limitations of those rights, in a positive manner.  I have modified
this form to make it more generally usable by other agencies and
institutions; where words or phrases are enclosed in square brackets [],
make your own substitutions.  Needless to say, have your agency's attorney
examine it before use.

The blank form below is modified from one used by the U.S. Geological
Survey, and is in the public domain.

Individual Volunteer Services Agreement

1a. Name of Volunteer
1b. Social Security number
1c. Date of birth
1d. Address, including zipcode
1e. Home telephone number

2a. Person to notify in an emergency
2b. Relationship to volunteer
2c. Address, including zipcode
2d. Telephone

3. Agreement by Volunteer:  I offer and agree to perform the services
described below without compensation to assist the [AGENCY] in accord with
the following understandings:

a. I will contribute my services from ________ (date) to approximately
______ (date).

b. This volunteer service will not confer on me the status of a [federal]
employee; however, while acting within the scope of this Agreement, I am
covered under the provisions of the:

[The USGS cites the "Federal Tort Claims Act, which protects a Federal
employee from liability for injury or damage to others while the employee
is acting within the scope of his or her duties," and the "Federal
Employees Compensation Act, which authorizes compensation for work-related
injury."  Substitute the appropriate national, state, or provincial laws.]

c. If I am less than [18] years old, my parent or guardian consents to this
Agreement by signature below.

d. I understand the health and physical requirements for performing the
services described in item 4 below, and certify that I know of no physical
condition or limitation that may adversely affect my ability to perform
these services.

e. Either I or the [AGENCY] may terminate this Agreement at any time by
notifying the other party in writing.

f. Because volunteers are not [federal] employees, their volunteer service
will not be creditable for leave accrual, retirement, or other benefit
purposes if they later accept a [federal] appointment.

Signature of Volunteer_________________________
Date____________

Signature of Parent or Guardian_________________________
(If volunteer is under 18)
Date____________

4. Project Description



[AGENCY] Supervisor (print)_______________________
Title/Position__________________
E-mail address___________________________

[NAME, ADDRESS, AND PHONE NUMBER OF AGENCY]

5. Agreement by [AGENCY]: Under the authorities of [cite statute numbers],
the [AGENCY] accepts this offer and while this Agreement is in effect:

a. the Volunteer is covered by the provisions of the [Federal Tort Claims
Act and the Federal Employees Compensation Act].

b. The [AGENCY] will provide for such materials and supplies, equipment,
support services, and facilities as are needed and are available to
accomplish this project as  agreed to in item 3 above.

Signature of [AGENCY] Official________________________
Name (print)___________________________
Title/Position______________________________
Office/Building__________________________
Date________________

6. Time and attendance : The volunteer must maintain a timesheet to ensure
coverage in case of injury and to verify creditable experience for
employment purposes.

7. Additional information:

a. Volunteer source (Be specific)
b. [AGENCY] retiree Yes__  No__
c. Faculty  Yes__  No__
d. Student  Yes__  No__
e. Volunteer T-shirt size  Small__ Medium__ Large__ Extra-large__

8. Termination of the Agreement

a. Total number of hours contributed by Volunteer
b. This agreement was terminated on ___________________ (date).

Signature of [AGENCY] Official__________________________
Signature of Volunteer_________________________________

_______________________________________

PRIVACY STATEMENT

The information requested on this form is confidential, though statistics
may be compiled from it.  Personal data will be used when emergency contact
is necessary.  Furnishing this information, including the social security
number, is voluntary, but failure to provide may result in nonacceptance as
a volunteer.

_______________________________________

Distribution: Original maintained in Division files
Complete copy to:
(1) Volunteer
(2) Supervisor
(3) Personnel Officer


Andrew K. Rindsberg                     Telephone (205) 349-2852
Curator, Paleontological Collection     Telefax (205) 349-2861
Geological Survey of Alabama            <[log in to unmask]>
P.O. Box O
Tuscaloosa, AL 35486-9780, USA
"I never let my schooling interfere with my education."--Mark Twain.