Essex Coronavirus Action - Business Signup
PLEASE READ THIS INFORMATION CAREFULLY. YOU WILL BE REQUIRED TO ELECTRONICALLY SIGN THE DECLARATION AT THE END OF THIS FORM TO SHOW THAT YOU HAVE READ AND UNDERSTOOD EVERYTHING IN THIS SECTION.

This form is for any business owner in Essex who wants to volunteer and help in their local community with vulnerable or self-isolating people during the Coronavirus / Covid-19 outbreak.

Essex Coronavirus Action is a collaboration between Essex County Council, The Essex Public Health Team and local Facebook groups to ensure that support assistance reaches the people who need it the most.

Once you have submitted this form, a member of the Essex Coronavirus Team will be in touch at the earliest possible opportunity. Please bear in mind that there may be a small delay due to the volume of people who are contacting us.

IMPORTANT INFORMATION REGARDING YOUR PERSONAL SAFETY AND THE WELLBEING OF OTHERS

It goes without saying that Covid-19 / Coronavirus is contagious. Therefore, it is your responsibility to ensure that you are only spreading kindness when volunteering in your local community. Wherever possible and practical to do so, please avoid physical contact and maintain a distance of at least TWO METRES between yourself and others while volunteering, and wash your hands regularly in line with the latest government advice. If you are delivering items, please leave them on the doorstep and let the recipient know that they are ready to be picked up.

IMPORTANT INFORMATION REGARDING THE USE OF YOUR PERSONAL INFORMATION

Any information submitted using this form will be stored by Essex County Council and only accessed by Essex County Council and those working on their behalf in accordance with their current GDPR and data protection policies. It may be shared with Provide, an organisation that works alongside Essex County Council, and other approved partners solely for the purposes of making sure that respondents are connected directly with members of their local community who are organising volunteering efforts.

For your information, you can read the relevant Essex County Council policies regarding data protection and GDPR at https://assets.ctfassets.net/knkzaf64jx5x/3ELBevLgnrxOqwr6i6EEME/95985ec440b441efcad32067836105f5/Privacy_notice_easy_read_guide.pdf

If you have any questions, please contact Kirsty O'Callaghan, Head of Strengthening Communities at Essex County Council. Email: kirsty.ocallaghan@essex.gov.uk

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Email *
Your Full Name *
Date Of Birth *
If you are under 16 years of age, we may need to contact your parent / guardian / carer for permission.
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DD
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Address *
Please enter your full address and postcode.
Telephone Number *
Please enter your full landline or mobile telephone number, including an area code.
The Name Of Your Business *
Please enter the full name of your business.
The Nature Of Your Business *
Please enter the main activity carried out by your business.
Full Contact Details For Your Business *
Please enter your business address, telephone number, website address (if applicable) and social media links (if applicable).
Tasks You Are Willing To Help With *
If someone in your local community is self-isolating, caring for someone who is self-isolating, or generally not in a position to leave their home, what tasks would you be willing to help with? Please select all that apply.
Required
Your Existing Skills And Experience *
Please select all of the relevant skills and experience that you have. PLEASE NOTE: In some circumstances you may be asked for proof / evidence of these.
Required
Your Availability *
Are there any days or times when you are generally unavailable?
Travelling Distance *
How far are you prepared to travel to support someone? Please reply with a 'radius,' so for example, 'Within a ten-mile radius of Chelmsford.'
Do You Hold A Current And Valid DBS (Disclosure And Barring Service) Check? *
Are You Prepared To Make Welfare Calls On Behalf Of Primary Care Services? *
A 'Welfare Call' is literally just checking to make that someone is OK and how they are feeling in general. If you are concerned, all you would need to do is let your contact know about them.
FOOD-RELATED BUSINESSES ONLY: Please Give Details Of Any Hygiene-Related Or Other Relevant Certifications That You / Your Business Currently Holds
Apologies for asking this, but it's merely procedure! We may ask to see proof of anything that you mention here, but it is purely to protect the interests of everyone involved with Essex Coronavirus Action.
Do You Wish To Add Any Additional Information?
This is optional.
Essex Coronavirus Action On Facebook *
Have you 'Liked' the Essex Coronavirus Action page on Facebook? This is the easiest way to keep up to date with the latest announcements and news about Covid-19 and volunteering to help in Essex. Search for 'Essex Coronavirus Action.'
DECLARATION *
Please enter your full name below to confirm that you have read and understood the information at the top of this form. We strongly recommend taking a few moments to read it again before completing this box. PLEASE REMEMBER that any information submitted through this form will be shared with Essex County Council and key partners for this project.
A copy of your responses will be emailed to the address you provided.
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