Emergency Support for Healthcare Workers at Harvard-affiliated Hospitals (Request Form for Workers)
PLEASE READ IN ENTIRETY BEFORE PLACING REQUEST.
We take request daily from 9-5pm and you should here from us within 24 hours after placing your request.

** This group is NOT officially affiliated with or sponsored by any medical school or hospital system **

WHAT IS THIS?
This form is intended for all healthcare workers at Harvard affiliated hospitals who are experiencing greater work-related responsibilities due to the ongoing COVID-19 outbreak and need to request support for support outside the hospital. Services including childcare, running errands (grocery/pharmacy runs), and others. If you are interested in requesting support, please fill out the form below. This is in an independent student effort and is not officially affiliated with Harvard University or any hospital.

The goal of this organization is to provide TEMPORARY SUPPORT for all healthcare personnel in immediate need of assistance. This temporary relief is to give providers time to locate other resources. Student volunteers are usually available to provide up to 10 shifts of services (childcare, grocery delivery, etc.). In the event of limited volunteers, you may be matched with a temporary volunteer who can provide partial coverage (e.g. less than 10 shifts). If ongoing assistance is needed, providers may send another request through the form or may coordinate independently with their assigned student.

WHAT HAPPENS AFTER I FILL OUT THIS FORM?
Once you complete this request form, a student coordinator will connect you with a student volunteer who can service your request. We process requests in less than 24 hours (with the aim to connect you ASAP). We will connect the two of you via email or phone, after which you can coordinate details.

DO I QUALIFY?
If you work at one of the Harvard affiliated hospitals you qualify! Please read more below for disqualifications.
If you or any member of your household (including yourself) meets any of the following criteria, or develops any of them while working with a volunteer, we are unfortunately unable to offer in-person services, such as childcare, to you at this time:
- Had COVID-19 like symptoms in the past two weeks (fever, cough, shortness of breath)
- Had explicit contact with a confirmed case of COVID-19 without proper protective equipment and have not yet been tested
- Traveled outside the country with Level 3 travel warning in the past month (https://wwwnc.cdc.gov/travel/notices)
- Is under active quarantine for COVID-19, even if asymptomatic
- Are not up to date on vaccinations, including annual influenza
In the event that anyone in your household or the volunteer assigned to you begins to experience symptoms or has a possible exposure to COVID-19, please contact us and services will be cancelled immediately. This is a necessary precaution to protect both our volunteers and providers.
We are happy to help anyone in immediate need on a temporary basis for childcare, however if you have the ability to pay moving forward, please continue to explore other resources so that we may dedicate our services to those most in need. In the event that requests exceed resources, priority will be given on a first come first serve basis. We appreciate your understanding.(Other childcare resources: https://docs.google.com/spreadsheets/d/1rTVXcRNyCUdz9Rg76jJkagaLk3JcVyZY5oIIfGj1h4M/edit#gid=687629193 ).

WHO IS THE STUDENT VOLUNTEER WHO WILL HELP?
The volunteer will be a graduate student in the Boston (Harvard, BU, NEU etc.). If graduate students are not available, you may be paired with an undergraduate volunteer. You will be asked to confirm that you are ok with the match before the connection is made. If the student, or anyone in their household, meets or develops any of the following criteria, they do not qualify to volunteer:
- Had COVID-19 like symptoms in the past two weeks (fever, cough, shortness of breath)
- Had explicit contact with a confirmed case of COVID-19 without proper protective equipment and have not yet been tested
- Traveled outside the country with Level 3 travel warning in the past month (https://wwwnc.cdc.gov/travel/notices)
- Reside in a household where someone Is under active quarantine for COVID-19, even if asymptomatic
- Are not up to date on vaccinations, including annual influenza
We have asked that student volunteers who engage in childcare review the following CDC recommendations and practice social distancing in other aspects of their life (e.g. limiting contact with other individuals as much as possible, try to keep 6ft distance between individuals, complete avoidance of groups of more than 10 people. (https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html).

DO I HAVE TO PAY FOR THIS SUPPORT?
This program does not make connections that involve financial transactions and is a temporary support network. However, you MUST reimburse the volunteer for any groceries or other goods purchased for you. It is highly recommended that volunteers be reimbursed immediately, but methods and timing are ultimately left to worker-volunteer coordination. Unfortunately we do not have the funds to provide financial assistance at this time.

HOW ABOUT THE HEALTH OF MY HOUSEHOLD?
We are committed to making this volunteering program as safe as possible for both the volunteers and workers making requests. Therefore, we have included the qualifications listed above for the health of workers, their households, volunteers, and the public. However, requesting support during this time is a personal decision. Please feel free to reach out with further questions.

WHAT IF I LIVE IN THE SUBURBS?
Most of our volunteers live in Boston and Cambridge and we try to make matches with volunteers who live near you. If you live in the suburbs this becomes challenging as only a few of our volunteers have access to cars. However, please feel free to still put in a request and we will try our best to match you with someone who has a car or think of other solutions. We apologize in advance if we are unable to do so. Please refer to the following link to find other options for childcare in MA during the pandemic: https://eeclead.force.com/resource/1584817665000/EEC_EmergencyProviderList

WHAT AGREEMENT AM I ENTERING?
This program is only to connect healthcare workers and staff with available students; we are not providing training or vetting anyone. Meeting the above qualifications are based on an honor system. All arrangements, including logistics regarding self-quarantining, social distancing, and protective measures, should be discussed between the worker and the student match.

WHAT IF I AM QUARANTINED AT HOME AND NEED SUPPORT?
We may be able to accommodate errand running & drop-off services for people who are currently quarantined or symptomatic on a case-by-case basis. We will not be able to provide any in-person services. Please feel free to elaborate on your situation in the comments box below and we will do our best to accommodate any grocery/pharmacy deliveries.

Questions or concerns? Email student.covid.response@gmail.com
Email address *
Name *
Hospital *
Where do you work?
Role at Institution (all workers eligible) *
Are you working from home? *
Phone Number *
To help coordinate with students
Preferred contact method *
Required
What service do you need? *
Required
How urgent is your need? *
If you selected childcare, please list number of children and ages.
If you selected childcare, what dates and times are you specifically requesting ? (Reminder that this service is meant to be temporary childcare support and that presently we can only offer 10 shifts of childcare)
Where would you like to receive your groceries/pharmacy delivery? We would prefer to meet at a Harvard affiliated hospital, but we may have a limited number of volunteers available for home delivery. If you need home delivery please specify location under "other"
Clear selection
Where do you live (area/zip code)? - No need to list address; this is just to match you with a nearby student for childcare/home delivery to reduce transportation use
Do you have pets in your home? If yes, what are they?
Please add any additional comments/thoughts you might have so we can make the best student connection for you (for example, do you have a language preference for childcare?)
I have read the above Healthcare Worker Recipient of Services Contract, and agree to the terms described. * *
Required
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