A volunteer pool is being created to provide support to Manitoba's health care system as our health care
workers respond to COVID-19.
Across our health system, regional health authorities and health care facilities are always looking for
qualified volunteers to support our employees and patients.
As a result, the volunteer screening process for the Northern Health Region (NHR) and Shared Health
locations in the Region has temporarily been amended in order to address the need for volunteers in certain areas across our system.
If you are interested in volunteering with the NHR either in an administrative capacity or having face-to-
face interactions with patients, please complete the initial electronic screening below and we will connect with you to discuss potential opportunities.
Volunteer opportunities exist across the province. If you are from outside the NHR, please contact your
Regional Health Authority for more information.
If you have trouble with this form, or are not comfortable with an online application please email
firstname.lastname@example.org or call 204-627-6803
1. Do you have any flu like symptoms including any of the following: fever, cough, shortness of
breath, running nose, headache, general weakness, or loss of taste or smell? *YesNo
2. Do you live with, or had close contact with, someone who is ill with fever and/or cough and flu-like
symptoms, while not practicing social distancing at home? *YesNo
3. Have you traveled outside the province of Manitoba within the last 14 days? *YesNo
Please try again 14 days following contact.
4. Have you had close contact with someone who is ill with flu like symptoms and has traveled
internationally within the past 14 days? *YesNo
5. Are you 18 years of age or older? *YesNo
I’m sorry, we are only accepting adult volunteers at this time.
The remaining questions are for our information and will not disqualify you for a volunteer position, they are simply designed to help us make appropriate assignments and inform you of the potential risks:
6. Are you over the age of 60? *YesNo
Please note that the World Health Organization (WHO) has indicated the risk for serious complications related to COVID-19 are higher in those over the age of 60. You may not have direct contact with patients who are ill during your volunteer post but it is important that you acknowledge this risk if you proceed with an application to
Do you acknowledge that you have read the risk and wish to proceed?YesNo
7. Do you have a comprised immune system? *YesNo
Please note that the WHO has indicated the risk for serious complications related to COVID-19 are higher in those who have compromised immune systems. You may not have direct contact with patients who are ill during your volunteer post but it is important that you acknowledge this risk if you proceed with an application to volunteer.
8. Do you have past employment or volunteer experience? (check all that apply) *In health careWith older adultsWith crisis managementWith confidential informationWith personal health informationWith crisis managementOther
9. Do you have any of the following skills? (check all that apply) *In health careNursingComputerData entryCall centreAdministrationMaking appointmentsOther
10. For the safety of our clients and patients, only people with current child abuse registry checks in
place will be permitted to occupy positions supporting children in our system. Are you able to supply us with a valid (within the last six (6) months) child abuse registry check? *YesNo
11. What community are you willing to volunteer in (check all that apply)? *Flin FlonThompsonSnow LakeThe PasLynn LakeLeaf RapidsGillamSherridonCranberry PortageCormorantMoose LakeEastervilleGrand RapidsThicket PortageIllfordWabowdenOther
12. Please indicate which category of volunteer role you prefer: *Patient interactionNo patient interaction
Full name *
Birth year *