Policy and Procedure Manual

ContentsActivities Request Policy........................................................................................................................................................4

Community Service Policy.....................................................................................................................................................4

Data Collection Policy & Protocol..........................................................................................................................................4

Donations Policy....................................................................................................................................................................4

Donation Documentation..............................................................................................................................................5

Financial Policy......................................................................................................................................................................5

Division of Duties...........................................................................................................................................................5

Executive Director:........................................................................................................................................................5

Executive Administrator:...............................................................................................................................................5

Center Managers:..........................................................................................................................................................6

Cash Receipts Procedures (AR)......................................................................................................................................6

Cash Disbursements Procedures (AP)...........................................................................................................................6

Bank Reconciliations......................................................................................................................................................7

Reconciliations of Other General Ledger Accounts.......................................................................................................7

Petty Cash Policy...........................................................................................................................................................8

Securing the Petty Cash Account...................................................................................................................................8

Creating a New Petty Cash Account..............................................................................................................................9

Receiving Cash...............................................................................................................................................................9

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Petty Cash Purchases and Vouchers..............................................................................................................................9

Reimbursing Petty Cash Account/Reconciliation of Account Activity............................................................................9

Closing Petty Cash Account.........................................................................................................................................10

Purchases....................................................................................................................................................................10

Credit Card Purchases.................................................................................................................................................10

Incident Report Policy.........................................................................................................................................................11

Member Confidentiality Policy............................................................................................................................................11

Purpose:..........................................................................................................................................................................11

Scope:..............................................................................................................................................................................11

Document Identification..............................................................................................................................................11

Recoveree Access to Protected Health Information....................................................................................................11

Member Release of Protected Health Information.....................................................................................................12

Retention of member files:..........................................................................................................................................13

Grievance Policy for HIPPA/ Ethics Violation...............................................................................................................13

Risk Management Policy.....................................................................................................................................................14

Mission Statement......................................................................................................................................................14

Goals Statement..........................................................................................................................................................14

Safety Policy........................................................................................................................................................................14

Social Media Policy..............................................................................................................................................................14

Staff HR Policies...................................................................................................................................................................15

Applications.................................................................................................................................................................15

Staff Supervision..........................................................................................................................................................15

Staff evaluations..........................................................................................................................................................15

Time Off Request Policy......................................................................................................................................................16

Training Policy.....................................................................................................................................................................16

Transportation Policy..........................................................................................................................................................16

Volunteer Supervision/Training Policy................................................................................................................................18

Working Remotely Policy....................................................................................................................................................18

Eligibility......................................................................................................................................................................19

Workspace...................................................................................................................................................................19

Safety Plan...........................................................................................................................................................................20

Overdose.....................................................................................................................................................................20

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Suicide Attempt- Someone at Risk for Suicide.............................................................................................................21

Emergency Supplies....................................................................................................................................................21

Emergency Contact Information.................................................................................................................................21

Facility Safety..............................................................................................................................................................21

Reporting an Emergency.............................................................................................................................................21

Criminal Activity/Crime In Progress Call 911...............................................................................................................21

Child Left Behind Policy...............................................................................................................................................21

Lost Child Policy...........................................................................................................................................................22

Telephone Recovery Script - Initial Contact........................................................................................................................23

Telephone Recovery Script - Follow Up...............................................................................................................................24

Absence Request Form........................................................................................................................................................25

Activity/Training Request....................................................................................................................................................26

Check Requisition Form...............................................................................................................................................27

Community Appearances and Events Tracking Log.............................................................................................................28

Community Service Application Form.........................................................................................................................29

Confidential Report of Incident...........................................................................................................................................30

Donation Receipt.................................................................................................................................................................31

Employment Application....................................................................................................................................................32

Grievance Form...................................................................................................................................................................33

Member Consent................................................................................................................................................................33

CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION........................................................................................33

Membership Form...............................................................................................................................................................33

Statement of Confidentiality Form..............................................................................................................................33

Code of Ethics Statement............................................................................................................................................33

Encounter Form...........................................................................................................................................................33

Recovery Plan..............................................................................................................................................................33

Social Media Policy Compliance Form.................................................................................................................................33

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Activities Request Policy

See Activity/Training Request Form

If you want to see HOPE represented at a community event and would like to volunteer for it or organize a few volunteers for the event, please fill out an activity request form to be reviewed by senior leadership to ensure we, as an organization are not over extending and are meeting community and event planning expectations.

Community Service Policy

See Community Service Application Form

Please have all those who are interested in fulfilling their community service hours ordered by the court, have them fill out a volunteer/community service application.

Data Collection Policy & Protocol

The idea of collecting data on individuals in recovery was not a quick sell to many of the AA members willing to help us create recovery centers, but data is vital and valuable information for our funders. A large part of our data collection is done with the initial membership form and the continual updating of our members information. Currently with the membership form and after June 1, 2018 via the RecoveryTrek data information system. This data platform will allow us to capture communications between the staff and the recoveree/ member. We currently capture data by using sign in sheets and call logs that allow us to collect numbers of people that use other resources in the center as well as member encounters.

Demonstrating successes at our recovery center will be critical to securing ongoing funding for all future HOPE centers. We will be participating in biannual meetings with all of our HOPE for NH centers. These gatherings are envisioned as opportunities to share successes and provide support in solving operational challenges.

Donations Policy

We are very appreciative and grateful of the many generous individuals who wish to donate items to our centers. We need to carefully manage donations of all kinds and make sure that they are documented. Not only for tax purposes, but in order to properly thank our friends for their contributions.

Each HOPE Center is unique in its way of operating and in the community that it serves. Therefore, what may be a relevant and useful donation to one Center, may not be to another. Use your best judgement when

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accepting donations. Are they needed? Do you have the room to store them? Are they perishable? These questions and others will help you determine if the donation is something you should accept into your Center.

PLEASE do not turn your center into a food or clothing pantry! There are others in your community already doing this, and you can refer these types of donations their way as well as our members that may need them. You can also work with these organizations to bring some HOPE volunteers/members to help them, which allows and shows them how to give back to their community.

Donation Documentation

See Donation Receipt Form

Upon receiving a donation of any kind, a Donation Receipt form MUST BE FILLED OUT by the person making the donation. Once completed, make a copy for the person and send the original copy to the Executive Administrator so we can keep track of donations coming into the Centers.

It is very important that we track each and every donation as small as they may seem. They add up quickly and we need to account for all donations to our Centers. We also need an email or address in order to thank our generous community.

Financial Policy

Division of Duties

The following is a list of personnel who have responsibilities within the organization:

Executive Director Executive Administrator, AP/AR Center Managers Treasurer Board Chair

Executive Director:

Reviews and approves all financial reports. Reviews and approves annual budget. Reviews and approves all contracts for goods and services that will exceed $200 over the year. Signs & Approves all invoices. With the Finance Committee develops the annual budget. Reviews and approves list of pending check disbursements. Authorizes all inter fund and intercompany transfers. Approves all reimbursements. Reviews and approves all bank statements.

Executive Administrator:5

Process Payroll Processes all receipts and disbursements. Processes purchase orders and requests for disbursements. Reconciles the statement of credit

card deposits and service charges. Receives, opens and date stamps all incoming mail. Mails all checks for payments. Photocopies all checks received in mail and distributes copies to appropriate individuals. Maintains and reconciles the general ledger monthly. Reconciles the bank accounts Prepares financial reports.

Center Managers:

Manages the petty cash fund Manage cash Double checks all reimbursement requests against receipts provided

Treasurer: Reconciles Bank statements

Board Chair:

Cash Receipts Procedures (AR)

The Executive Administrator receives all incoming mail. Next, the Executive Administrator prepares a deposit slip and deposits the funds into the appropriate account. The validated deposit slip is filed. All check copies are filed according to property and bank account by fiscal year. A check not yet deposited is secured.

Cash receipts for the centers are the responsibility of the center manager. Center managers will convert cash into a check payable to Hope and mailed to the organizations post office box.

Cash Disbursements Procedures (AP)

Incoming invoices will be opened and date stamped by the Executive Administrator.

The staff person responsible for ordering the product or service will check the validity of the invoice against quotes and work accomplished/delivered and approve the invoice.

Bi-weekly, Accounts Payable (AP) reports are run by the Executive Administrator and given to the Executive Director for approval.

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The Executive Administrator is responsible for the preparation of disbursements. All disbursements are to be made by check.

Once the AP amount has been approved, the Executive Administrator prints the checks from the system. The checks should be attached to the invoice and other supporting documentation. The checks are signed by Executive Director. All checks will be mailed as soon as this process is completed, there is no hold.

Supporting documentation will be filed in the appropriate vendor files. The Executive Administrator will utilize the paid invoice files to respond to any discrepancies which arise with vendors or other payees.

Bank Reconciliations

Bank statements are to be received by the Executive Administrator. The Executive Administrator will reconcile each account monthly.

When reconciling the bank accounts, the following items should be included in the procedures:

A comparison of inter-organization bank transfers to be certain that both sides of the transactions have been recorded on the books.

An investigation of items rejected by the bank, i.e., returned checks or deposits. An accounting for the sequence of checks both from month to month and within a month. Investigate and write off checks which have been outstanding for more than 6 Months.

Completed bank reconciliations will be reviewed by the Treasurer and initialed. The Executive Administrator prepares any general ledger adjustments.

Reconciliations of Other General Ledger Accounts

Each month the Executive Administrator will review the ending balance shown on balance sheet accounts such as the cash accounts, accounts receivable and accounts payable. The Treasurer of the Board of Directors reconciles the “due to restricted” revenue and restricted savings account balances to the general ledger.

Assets - These accounts will include cash, petty cash, prepaids, property, equipment and fixtures, and security deposits.

Cash - The balances in cash accounts should agree with the balances shown on the bank reconciliations for each month.

Petty Cash - The balance in this account should always equal the maximum amount of all petty cash funds. The current amount equals $200.00.

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Prepaids - The amounts in these accounts should equal advance payments paid to vendors at the end of the accounting period.

Property, Equipment & Fixtures - The amounts in this account should equal the totals generated from the audited depreciation schedules. When additional purchases are made during the year, the balances in the accounts may be updated accordingly.

Security Deposits - The balance in this account should equal amounts paid in escrow to landlords and lessors and should be updated as applicable.

Liabilities - These accounts are described as accounts payable, payroll tax liabilities, loans and mortgages payable, and amounts due to others.

Accounts Payable - The balance in this account should equal amounts owed to vendors at the end of the accounting period and the aging report.

Payroll Tax Liabilities - The amounts in these accounts should equal amounts withheld from employee paychecks as well as the employer’s portion of the expense for the period.

Due to Others - If there are any amounts owed to others at the end of the period, they should be recorded and the correct balance maintained in the general ledger accounts.

Income/Expenses - These accounts are described as income from donations, grants, rental income, etc. and other expense line items such as salaries, consulting fees, etc.

Income - The amounts charged to the various cash accounts should be reconciled with funding requests, funders reports, draw down schedules, etc.

Gross Salary Accounts - The balances in the gross salary accounts should be added together and reconciled with the amounts reported on quarterly payroll returns.

Petty Cash Policy

This policy defines the policies and procedures to be followed when starting, administering and ending the use of petty cash funds for small incidental cash purchases by employees for an amount up to $200.

Hope’s policy is to create a petty cash fund for a Center when appropriate to improve operations based on providing availability to cash for small purchases of products and services where it is not practical or efficient to make the purchase through the normal process of a request (Check Requisition).

Securing the Petty Cash Account

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The manager assigned oversees ensuring the security of petty cash held by their respective center. All cash and vouchers for expenditures (receipts) must be held in a locked cash safe box with access limited by a key held by the manager. The manager in charge is responsible for the petty cash at all times.

The petty cash fund will be reconciled monthly by the manager and audited occasionally by the Administrator or Executive Director. The manager must ensure at any given time, receipts plus cash on hand equals the balance on the register, and all cash is accounted for. The petty cash must always be maintained separately from other cash drawers, any other revenue and personal money.

Creating a New Petty Cash Account

1. Write a request providing justification of the petty cash account along with designation of the manager in charge. This should include the manager’s name, center/department, date and signature.

2. Create an account payable request for the approved petty cash fund 3. The manager will receive funds along with the petty cash policy which must be signed upon receiving.

Receiving Cash

1. All Cash received must be logged on your petty cash transaction register and have documentation in the form of a 2-part carbonless completed cash receipt form.

2. The cash receipt form must clearly state the purpose of the cash receipt with their name and contact information for record keeping. The duplicate copy is to remain in the receipt book.

Petty Cash Purchases and Vouchers

An employee making a purchase with petty cash must follow this process:

1. Obtain approval from Center Manager.2. A “voucher” must be completed anytime cash is issued from petty cash when there is no receipt. 3. Obtain petty cash funds for the equivalent amount of the petty cash voucher4. Make the purchase and obtain a receipt5. Provide the receipt & remaining cash to the Center Manager

If an employee does not obtain petty cash funds prior to the purchase, the employee should complete voucher, submit receipts and receive reimbursement as soon as possible after purchase is made.

Reimbursing Petty Cash Account/Reconciliation of Account Activity

Reconciliation of account petty cash fund activity must be completed once per month. All reimbursement requests must be made by making a request to accounts payable.

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Transaction registers are the document used to reconcile petty cash. This register must include the Managers name, center, date, and each receipt. Photocopies of applicable pages from the cash receipt logbook must be included. Overages and shortages are the responsibility of the center manager to explain. Overages and shortages must be entered into the transaction register.

Closing Petty Cash Account

When petty cash is no longer needed for a department the fund should be closed by reimbursing the fund as outlined above and then the account should then be returned to the Executive Administrator providing a credit back to the original account withdrawn from.

Purchases

See Check Requisition Form

When the normal cash disbursement procedure of an invoice, etc., is not appropriate (i.e., postage, petty cash, etc.), a check request should be completed and forwarded with any order form or other documentation to the purchaser’s supervisor and/or the Executive Director for approval. Purchase order/check request completion is as follows:

Complete the information based on who you are making your purchase from:o Vendor Name, Vendor Address, Attention? Enter name of specific person information is to be

sent to (for check requests only) Enter name of Center, if applicable Enter description of what is being purchased, quantity, unit price Complete bottom section to indicate:

o Is this a check request? Indicate when you need check returned to you or Indicate when check should be mailed Indicate if the backup paperwork you’ve attached needs to be mailed with check Sign the form Have supervisor sign the form (MUST HAVE SUPERVISOR SIGN BEFORE SUBMITTING) If signature can’t be obtained, must have Executive Director or Executive Administrator sign. In the absence of backup materials, or exact pricing the Executive Administrator will

arrange for alternative payment.

Credit Card Purchases

Only the Executive Director carries corporate credit card in his name.

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Incident Report Policy

See Confidential Report of Incident

All incidents such as staff or volunteer injury, confidentiality breach, police or first responder involvement, serious center code of ethics violations, etc. must be filled out the same day and submitted to the program manager and the ED. The organization has an obligation to report such incidents to various funders and insurance providers.

Member Confidentiality Policy

Purpose: To establish guidelines for the contents, maintenance, and confidentiality of member records that meet the requirements set forth in Federal and State laws and regulations, and to define the portion of an individual’s healthcare information, whether in paper or electronic format.

Scope: This policy applies to all employees of HOPE FOR NH RECOVERY. Responsibility: All Hope for NH staff and volunteers.

Policy: Hope for NH ensures that the member file is maintained in a manner that is consistent with the legal requirements, current, standardized, detailed, organized, available for review upon request.

Confidentiality: All personnel having access to member records must sign the recovery community center confidentiality statement.

Recovery/Medical /Dental Health Information may not be disclosed without the consent of the member. Members will be afforded the opportunity to consent to or deny the release of identifiable information except as require by law. Each member record will be filed, stored, restricted from public access.

This system will assure ease of retrieval, availability and accessibility as well as confidentiality of the member protected file. All members will have the ability to review, inspect and/or obtain a copy of their Protected Health Information in their member file upon request.

Document Identification

All documents must be identified so that proper filing will be completed accurately.

All documents should have a member number clearly identifying the member so that all documents are placed in the correct member Recovery file. The member number uniquely identifies each individual member.

Recoveree Access to Protected Health Information

All members will have the ability to review, inspect and/or obtain a copy of their information in their member file.

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Members may request to review and inspect their member files at any time.

A member does not have the right to immediate access to his or her recovery/medical/dental record under the HIPAA Privacy Rule.

Member Release of Protected Health Information

To provide practices protecting the confidentiality, privacy, and security of all Protected Health Information in compliance with patient expectations, regulations, and community standards; including but not limited to the Confidentiality of Medical Information Act and Health Insurance Portability and Accountability Act (HIPPA.):

Recovery/Medical Records Staff will never under any circumstances release Recovery/Medical/Dental Record Information without a signed Authorization for Use and/or Disclosure of Protected Health Information Form.

Members may request a copy of their files by completing and signing an Authorization for Use and/or Disclosure of Protected Health Information Form.

All members recovery information requests will be completed within 10 business days. The HIPAA Privacy Rule requires HOPE FOR NH, to act upon a member's request to amend Protected

Health Information about them that they believe is incorrect or erroneous that we keep in a “designated record set,” medical and dental health record. Requests for amendments to Protected Health Information must be acted on within 60 days of receipt of request. Up to an additional 30-day extension is allowable if HOPE FOR NH is unable to act on the request within the deadline, but HOPE FOR NH must provide the member a written reason for the delay and the date by which HOPE FOR NH will complete the action on the request. This written statement describing the reason must be provided within the standard deadline. HOPE for NH may only extend the deadline once per request for amendment. Confidentiality Breach Allegation.

To provide guidelines for handling a member's complaint or allegation of confidentiality breach.

Submit to ED for review within the same 24-hour period Complete Revision must be done within 24 hours HOPE FOR NH assures the Member that the center will honor the recoveree’s right to file a complaint

and will not retaliate against them or deny services based on filing a claim. Hope for NH, Notice of Privacy Practices, informs our members of their rights under HIPAA’s Privacy

Rule to file a complaint with our ED and the Office of Civil Rights (OCR) when they have reason to believe we have violated their privacy rights.

The Recovery Center manager will take all complaints and/or allegations of non-compliance seriously and will fully investigate the allegations to determine what course of corrective action, if any, needs to be taken.

The ED or appointed designee will notify the patient in writing the outcome of the investigation and what corrective action, if any, was taken within 60 days.

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Retention of member files:

HOPE FOR NH must maintain member files on all members in accordance with accepted professional standards and practices. The member files are completely and accurately documented to the best of our ability, readily accessible, and systematically organized to facilitate retrieving and compiling information.

HOPE FOR NH recognizes the importance of confidentiality of member information and provides safeguards against loss, destruction, or unauthorized use. Written procedures govern the use and removal of records and the conditions for release of information.

Destruction of recovery/Medical/Dental Record Policy

To provide guidelines on the removal, destruction or recycling of paper and electronic medical/dental records properly. To ensure that during the destruction process the members Protected Health Information is not improperly disclosed.

HOPE for NH has a duty to protect the confidentiality and integrity of confidential recovery/medical/dental information as required by law, professional ethics, and accreditation requirements.

Protected Health Information may only be disposed of by means that assure that it will not be accidentally released to an outside party.

All health information must be destroyed in a shredder as appropriate to the existing laws for HIPPA

Grievance Policy for HIPPA/ Ethics Violation

If a member feels their HIPPA rights or 42CFR laws have been breached they can file a grievance with the Executive Director, this grievance will be reviewed and documented by the Board of Directors and resolution will be submitted to the person submitting the grievance within 30-60 days.

In the case of a member grievance with a staff member this shall be written and submitted to the ED to be resolved within 14 days

See Grievance Form

Reoccurrence Policy

Volunteer: The policy on reoccurrence of a volunteer that is noticeably being disruptive, is they will be asked to take a break from volunteering until such time as the center manager and staff consult with a decision on the ability of the volunteer to return.

Staff: Staff that has a reoccurrence will be asked to step down temporarily and take immediate care of their health in hopes to address the reoccurrence and return to work.

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Risk Management Policy

Mission Statement

The HOPE for NH Recovery organization BOD has a moral and legal duty to its members, employees, and donors. It will meet its duty by ensuring that risk management plays an integral part in sound governance at both a strategic and operational level.

The Board of Directors will support the risk management effort through setting policy and providing broad guidance on goals and objectives. However, risk management is an active process that requires cooperation by all managers, employees, and—where appropriate—the larger community. To that end, the Hope Board accepts that it must take a leadership role in seeing that appropriate measures are undertaken.

Goals Statement

The Board of Directors authorizes the establishment of a Risk Management Committee. The Committee shall be chaired by the finance officer, and its responsibilities shall be:

Identifying and assessing safety and financial risks Selecting and implementing safety and financial risk control measures Providing a yearly review of risk management efforts and reporting to the Board

These activities shall be undertaken in the service of the risk management mission statement, and to that end risk management practices are undertaken to reduce the cost of risk to HOPE for NH Recovery and to maximize benefits of opportunities that the community may encounter.

Safety Policy

To assist in providing a safe and healthy work environment for employees, volunteers, visitors, and members, HOPE shall maintain a safe workplace. The Recovery Center Manager has responsibility for maintaining a safe workplace. Safety depends on the alertness and personal commitment of all. An emergency fire evacuation plan will be reviewed not less than every 90 days for safety. Building perimeter and bathrooms must be checked on a regular basis to ensure the building is secure.

Social Media Policy

See Social Media Compliance Form

If staff does “friend” or “Add” your member to any social media site IE: Facebook, Google plus, twitter, Instagram etc. All communications with that member will be made accessible to the center manager and/or the Executive Director should the need arise.

There is a form to sign for such access in the employee package. We ask you keep your comments about your specific work day absent from conversation on social media and maintain member confidentiality at all times.

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There is a document that will be signed by staff giving access to social media sites in the event of a complaint that needs to be further investigated.

Staff HR Policies

Applications

Hope for NH Employment Applications are available upon request for the various jobs available at each center.

Staff Supervision

All staff will report to their direct supervisor which is listed on their offer letter. The staff will be required to attend weekly documented supervisor lead staff meetings Individual documented supervision meetings as needed

The reporting structure is as follows:

If you have an issue that needs to be addressed, you will first go to you direct supervisor with the issue. If the issue needs further attention you will make the ED aware of this issue. If the issue needs further attention after you have brought your concerns to the two previous

supervisors, please reach out to our Board Chair. Current contact information on this individual is listed on our website.

Staff evaluations

Staff evaluations will be done by your direct supervisor:

After the 90 day initial hiring period After the first year of employment Yearly after that, in the month of December.

If the evaluation falls below standard:

A verbal warning will be given. More than three evaluations that fall below standard or two written warnings consummate with

Center policy infractions can result in termination. Termination can happen in the event of serious policy infraction consummate with the risk to our

guests and members as well as our organization.

TRAINING REQUIREMENTS FOR STAFF: ALL STAFF WILL BE REQUIRED TO COMPLETE OR SUBMIT DOCUMENTATION ON THE FOLLOWING TRAININGS BEFORE THE 6 MONTH EVALUATION WITH SUPERVISOR.

All Staff:

Recovery Center Orientation

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Policy and Procedure review Peer recovery coach training in some form ie: CCAR Model training Overdose prevention naloxone intervention training (NARCAN Training) CPR HIV & Aids/Hepatitis C education Harassment Training

Time Off Request Policy

See Absence Request Form

Please fill out a time off request form and submit to supervisor for approval no later than two weeks before the request so managers have ample time to approve or deny request.

Training Policy

See Training Effectiveness Evaluation Form

All trainings must be followed up with a survey of effectiveness evaluation forms to be kept in HR files with the resumes of the trainers doing the work.

Transportation Policy

All guests that will be transported to and from the Center will be required to buckle up. All staff that is transporting any guests or members to any events or appointments will be cleared to do so by Human Resources. To be cleared by Human Resources you must have a valid license and insurance card on file with the HR department. There is NO SMOKING at all in the van. Texting and driving is against the law in NH. New Hampshire is a hands-free state. That means please do not use your phone in any way while driving. Driving under the influence will result in immediate termination from duties.

Heading Out: Before you go out on an assignment, learn about the area and what precautions you should take. Map your route. Make sure your mobile phone battery or pager is charged. Leave a complete itinerary with the appropriate contact at your HOPE, including an expected time of

return. Leave valuables at home, locked in your office, or in your car's trunk. Separate your house keys from car keys.

Pre-Trip Inspection: If you are driving to your assignment in your own vehicle or the HOPE vehicle, make certain the vehicle

is well-maintained and key safety equipment is working as intended (the headlights and brake lights

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work, the wiper blades clean (not smearing), the horn honks, the brakes slow and stop the vehicle, tires have treads, etc.)

Check that the gas tank is filled at least half way. Keep the doors locked. Keep the windows rolled up whenever possible. Adjust your driving speed to weather conditions (slippery surface, poor visibility, bridges that freeze

before roadways, etc.). Watch roads. In urban areas, check for potholes, dark unlit areas, broken glass and debris, dead ends,

and roadblocks. In rural areas, watch for narrow, winding roads with no shoulder, animals in the roadway, and unpaved roads.

Seasonal issues that can occur - flooding streams, avalanches of snow, rocks or mud, amorous animals (moose, deer, and elk) lured to the roadway, etc.

Keep your car in gear while waiting at traffic signals and stop signs. If approached or threatened, honk your horn and drive off.

Drive in the lane closest to the center of the road to give yourself maneuvering room. Leave enough space between your car and the car in front to permit you to go around it quickly if

necessary.Parking Tips: When parking your vehicle, park as close to the entrance as legally possible (under a street light at

night). Avoid parking next to vans, campers, or trucks that could conceal someone from your view. Back into slots in an underground garage or parking lot. Engage the parking brake. Have exact change for parking meters (but don't keep change in your vehicle). Take the parking lot ticket with you. Check your surroundings before unlocking the door. If anyone strikes you as suspicious, don't get out

of the car. Don't leave keys in the ignition. Don't leave a spare key hidden in or on the car. Don't leave packages or briefcases etc. on car seats; they're only a temptation to break in and steal. Lock your vehicle.When Trouble Materializes: When you have car trouble, drive to a busy, well-lit street if possible. Engage the parking brake and turn on the vehicle's flashing lights. If you have a mobile phone, call for assistance (police, a towing service, a friend, colleague, etc.). Wait inside your car with the windows rolled up and the doors locked until the person you called

arrives. Never leave with an unknown person to seek help. Instead, through a closed window, ask the person

to call a towing service or the police if you do not have a phone.

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When You're Fearful: If you think someone is following you while driving, keep driving until you find a safe area; the nearest

police or fire station, open gasoline station, or grocery store where you can call the police. While driving to the safe area, attract attention to yourself by honking your horn in short blasts and by

turning on the flashers. Don't drive home, pull into a driveway, or pull over to the side of the road where you could be trapped. Try to record the license number, color, make, and type of vehicle and report it to the police.Stay Safe: When returning to your vehicle, carry your key in your hand. Pay attention to occupied vehicles around you. Check under the vehicle and in its interior to make certain no one is hiding there before you enter. Lock the doors as soon as you enter the vehicle.

Volunteer Supervision/Training Policy

We make it a priority to be mindful that volunteers need supervision as well as staff.

All volunteers including community service workers must first attend a volunteer training. Center manager or volunteer coordinator (if one is on site) will provide supervision for peers and sign

off on community service hours. Volunteers are encouraged to attend and experience a range of meetings to become familiar with the

different pathways of recovery in order to help explain them to members. Volunteers will be invited to take advantage of all free trainings offered on new policies and protocol in

the centers and programs they volunteer in.

Working Remotely Policy

A mobile workforce, or working remotely is the idea that in today’s world of connectivity, some employees do not need to be in an office to accomplish their work. Having a computer, internet service, and a phone is all some employees need to be connected, and do the work that their job requires. There are many different situations when Hope employees may not be in the office, and can work remotely. “snow days” are just one example of a situation that working remotely may be needed.

Working remotely is not a formal, universal employee benefit. Rather, it is an alternative method of meeting the needs of Hope. The privilege of working remotely is only available to Hope employees who have been with the organization for longer than 6 months, and are in excellent employment standing. They must also be excellent self-starters who can work with limited supervision. Working remotely is not the same as field work, and this policy does not apply to coaches in the field.

Hope’s policies for working remotely are as follows:

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Eligibility

Successful employees have the support of their supervisors and 6 months of employment longevity. Employees will be selected based on the suitability of their jobs, an evaluation of the likelihood of their being successful at being self-driven, and an evaluation of their supervisor’s ability to manage remote workers. Each department will make its own selections.

Workspace

It is expected of the employee when working remotely that they have a designated space to perform job functions. It should be quiet, and visibly appropriate. When participating in on-line meetings remotely, you are still representing Hope, and what is visible in your background should have a professional look. Children and pets and other people should not be visible, audible, or interrupt your meetings.

Any Hope materials taken home should be kept in the designated work area at home and not be made accessible to others.

Hope assumes no liability for injuries occurring in the employee’s home workspace. Hope is not liable for loss, destruction, or injury that may occur in or to the employee’s home. This includes family members, visitors, or others that may become injured within or around the employee’s home.

Dependent CareWorking remotely is not a substitute for dependent care. Remote workers will not be available during company core hours to provide dependent care. If you have dependents that are home, they must not require anything from the remote worker.

CommunicationEmployees must be available by phone and email during core hours. All client interactions will be conducted on a client or company site (welkin/O365). Participants will still be available for staff meetings, and other meetings deemed necessary by management.

Compensation and Work HoursThe employee’s compensation, benefits, work status and work responsibilities will not change due to working remotely.

The amount of time the employee is expected to work per day or pay period will not change as a result of working remotely.

The employee remains obligated to comply with all company rules, practices and instructions when working remotely. It is no different than being in the office in that, you must be 100% ready and available to handle any and all work tasks.

If you have any questions regarding working remotely, please contact your direct supervisor.

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Safety Plan

Overdose

Call 911 before all else, Staff that is trained to administer Narcan will calmly act in accordance with the Narcan training.

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Suicide Attempt- Someone at Risk for Suicide

If during a coaching session your recoveree expresses he/she does not want to live anymore and they tell you they have a plan to end their life. Or the individual discloses they are going to end the life of a loved one or someone else. You have a duty to report that to the proper authorities. First step is do not leave the person alone. Get the attention of another coach preferably a supervisor to help you with the current situation. Your supervisor will determine which agency needs to be reported to on such matters. If the manger is not available you need to contact local EMT/ Fire Rescue for the suicide attempt, and fire, EMT, and local police for the individual threatening the safety of others.

Emergency Supplies

Emergency supplies are to be checked on a weekly basis by the Center Supervisor to ensure that kits are stocked adequately.

Emergency Contact Information

Emergency contact information should be posted at each location along with the Evacuation Plan Fire diagram.

Facility Safety

Fire extinguishers should be clearly visible and maintained to fire code. Each location is to post diagram of the locations Floor Plan, containing all the following information: All Exits, All fire extinguishers, and Emergency Contacts including Emergency and Non-Emergency Police and Fire Departments, Poison Control and the Centers Managers telephone.

Reporting an Emergency

(CALLING 911) Post each call to 911, the Center manager is to be notified and an incident.

Criminal Activity/Crime In Progress Call 911

Child Left Behind Policy

Child left at the facility in the event a child is left at a Hope for NH with no parent/guardian in the building the following procedure should be followed:

Determine the name and age of the child. If child is involved in a program, contact the Program Director or staff responsible for the program. The Program Director will call parent or emergency contact (if known). Remain with the child until a parent or guardian is reached. If necessary, contact Local PD for

assistance.

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Lost Child Policy

A child shall be considered missing at the time of a parent, instructor, responsible sibling or other adult reports such and a cursory search does not produce the child. When a child is lost, the following steps will be taken:

The Supervisor will obtain complete description of child and see that it is distributed. Include name, age, physical description, clothing, time and place last seen.

All entrances/exits will be secured by either locking or stationing a staff member at the door. All areas generally staffed, i.e., pool, locker rooms, etc. will report promptly any pertinent

information. Supervisor will assign staff to search all building and grounds After all available means of locating the

child have failed, Supervisor will notify:

Parent/guardian Police

Entrances will remain secured until child is found

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Telephone Recovery Script - Initial Contact

Telephone Contact

Hello my name is _______ , calling from Manchester Recovery Community Center. I am a volunteer for the Telephone Recovery Support Program. I'll be calling you once a week for at least twelve weeks to check in and see how your recovery is going. Do you have any questions?

1. “Are you comfortable with sharing what your drug of choice was?”

2. “So, how is your recovery going?”

3. “Have you been able to stay away from alcohol and other drugs?”YES NOIf “yes”, praise recoveree (“That’s great”…..”Good job”, etc.) If “no”, ask recoveree if they are interested in getting some support andgetting back on track. Skip to #5

4. What supports are you using that are helping you stay in recovery?(Outpatient, 12-Step meetings, Church, etc.) Skip to #6

5. Ask recoveree if they need detox or treatment.If “yes”, go to resource booklet and give the recoveree phone numbers for local resources. Ask if we could call them back to see how they made out.If “no”, ask “What is preventing you from getting back into recovery right now?”

6. “What are the top two (2) reasons you are staying in recovery today?”

End of Call

7. “Have you found this telephone checkup call helpful?” Yes No

8. “Is this a good day and time to call you next week? “ Yes No

9. “If we don’t reach you, can we leave a message?” Yes No

10. “Do you have another phone number (such as a cell or family) that you would be willing to give me?”Yes No

11. “We will be calling you next week”

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Telephone Recovery Script - Follow Up

Telephone Contact

Remember to look at the comments on the service log to get an idea about what has been going on with this recoveree.

Hello my name is _______ , I am calling you from Manchester Recovery Community Center as part of the Telephone Recovery Support Program.

How has your recovery been going?

12. Have you been able to stay away from alcohol and other drugs? Yes NoIf “yes”, praise recoveree (That’s great”….”Good job”, etc.) Skip to #3If “no”, ask recoveree if they are interested in getting some support and getting back on track. Go to #2

13. Ask recoveree if they need detox or treatment Yes NoIf “yes”, go to resource booklet and give the recoveree phone numbers for local resources. Ask if we could call them back to see how they made out.If “no”, ask “What is preventing you from getting back into recovery right now?”

14. What supports are you using that are helping you stay in recovery.(Outpatient, 12-Step, Church, etc.)

End of Call

1. “Have you found this telephone checkup call helpful?” Yes No

2. “Is this a good day and time to call you next week? “ Yes No

3. “If we don’t reach you, can we leave a message?” Yes No

4. “Do you have another phone number (such as a cell or family) that you would be willing to give me?”Yes No

5. “We will be calling you next week”

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Absence Request Form

Absence Information

Employee Name:

Department:

Manager:

Type of Absence Requested: ___ Sick ___ Vacation ___ Bereavement ___ Time off without pay

___ Military ___ Jury Duty ___ Maternity/Paternity

Dates of Absence: to

Reason for Absence:

Employee signature Date

Manager Approval

Approved Rejected Comments:

Manager signature Date

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Revised 11/9/2017

Activity/Training Request

Date:

Person requesting: Center:

Name of event:

Sober social event ☐ Fundraiser ☐ Training ☐ Committee ☐Date of event: Time of event: From: To:

If this will be an out of center event, address:

Describe event:

What items will be needed?

Cost: $ Funds needed by what date?

Signature:

Please attach print materials (i.e. Flyers) about your event for review.

Upon completion of event, send sign in sheets to the executive office.

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Amount approved: $

Approved by: Date:

Paid out: $ Petty Cash ☐ Check #: Date:

Receipts received ☐

(Revised on 7/5/2016)

Check Requisition Form

Vendor/NameDate

Address

City, State, Zip Amount

Purpose

G/LCost

Center

Your Signature

Manager Approval

Final Approval

Submit the request to your supervisor. Be sure to scan all

27

receipts and attach them to the email.

Revised 11.9.17

Community Appearances and Events Tracking Log

Event Name: Date:

Community Collaboration:

Staff Member:

Participants’ Name: (Please print)

28

29

Important Contacts and Notes

Community Service Application Form

Date: Member #

Name: D.O.B. _ _ / _ _ /_ _ _ _ Gender: M ☐ F☐ T☐ Address: City: State: Zip: Email: Phone: How did you hear about us? Media ☐ Friend ☐ Family ☐ Current Member ☐ Mental Health Provider ☐

Primary Care Provider ☐ Probation/Parole ☐ Law Enforcement ☐ EMT/Fire ☐ Hospital/ED ☐ Passing by ☐Is your volunteering to fulfill community service? Yes ☐ No ☐ How Many hours?

If community service, where will the letter be sent?

What types of things do you like to do?

What are you interest in doing? (Check all that apply)

Group Facilitator ☐ Recovery Event ☐ Fund Raising ☐ Other:

Rate your computer skills: Excellent ☐ Good ☐ Fair ☐ Poor ☐Are you willing to attend a 1-hour orientation? Yes ☐ No ☐Are you bilingual? Yes ☐ No ☐ If yes, what language?

Would you like to start a group? Yes ☐ No ☐

What type of group is it? What is the name of the group?

Who is the alternate facilitator? Alternate’s phone #:

☐By checking the box, you are acknowledging an understanding and agreement to the following statement:

I agree to keep a total number of participants for this group and add the number to the Center’s sign-In book every time

this group meets indicating the accurate date, name of the group, and the total number of people in attendance.

Signature: Date:

Follow up by:

Supervisor Signature: Date: ____________________

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Confidential Report of Incident

Date of Incident: _____________ Time of Incident: _____________ Place of Incident: __________

Person completing Report: Signature:

Description of Incident:

Below this line completed by Hope Only

Corrective Plan:

Supervisor signature Date Action Plan Completed

THIS RECORD IS KEPT IN HR FILES

( ) Executive Director ( ) Center Manager

Corrective Plan: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Executive Director Signature Date

ADD ADDITIONAL PAGES AS NEEDED31

(Revised on 10/2/2017)

Donation Receipt

DONATION

RECEIPTTO BE USED FOR NON-MONETARY DONATIONS OF GOODS OR SERVICES TO HOPE FOR NH RECOVERY FROM INDIVIDUALS

OR COMPANIES. Tax ID 02-0521502

For Completion by Donor:

Contact/Donor: ______________________________________Date: ______________________

Name of Business: ________________________________________________________________

Street: ______________________________ City: _________________________ State: ______

Zip: ________ Phone:_________________________ Email:_______________________________

Description of donation and its purpose (please be specific & descriptive including estimated dollar value:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Thank you for your donation!

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Hope For NH Recovery PO Box 358, Manchester NH 03105 Phone 603/935-7524 Fax 603/232.3758 info@recoverynh.org

Employment Application

Today’s Date __________________ Position Applying For___ __________________

The primary role of all Hope for NH recovery center employees, is to be welcoming, empathetic listeners. Each visitor has his/her own path to recovery; their own individual needs; and their own story that has motivated them to try a life in recovery. It is through engaging people, asking questions and trying to make them feel welcome that we succeed in being a source of comfort and support for everyone who wants or needs it. Thank you for your interest in being a part of the healing that is happening at the recovery center.

Personal Information It is our policy to keep this information confidential.

Name________________________________DOB_______________Gender: M / F (circle one)

Address:__________________________________City_________________Zip Code________ Home

Phone___________________________ Cell Phone:______________________________

Email______________________________________________

Are you a person in recovery? YES NO

If yes, how long have you been in recovery_____________________

If yes, how would you characterize your current recovery? (Please circle all that apply.)

12 step Faith community Chemical Replacement Therapy Recovery Assisted with Medication Do you have therapeutic support?

Other approaches: ______________________________________________________________________________

Is your recovery based on......... your personal addictions? ……someone else’s addictions?

________________________________________________________________________________________________

Why do you want to work with the recovery community?

________________________________________________________________________________________________

________________________________________________________________________________________________

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References and Previous Experience

Please provide two personal or professional references.

Name ____________________________________

Phone_____________________________ Email:_________________________________

How long and in what capacity do you known them?

NAME______________________________________________

Phone ___________________________ Email:__________________________________

How long and in what capacity do you known them?

________________________________________________________________________________________________

Are you currently employed? Yes No

If so, where?

________________________________________________________________________________________________

How long have you worked there?

________________________________________________________________________________________________

What do you do there?

________________________________________________________________________________________________

Please outline your previous work or volunteer experiences.

__________________________________________________________________________________________________

__________________________________________________________________________________________________

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Please list any specific skills or experiences that you would like to bring to the recovery center:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Other relevant information

The mission of all recovery centers is to provide a safe, substance-free environment for people in recovery. It is of primary importance that we ensure the safety of our guests. A past conviction will not necessarily prohibit an applicant from becoming a volunteer or recovery worker, as we have confidence in a person’s ability to turn his or her life around. However, we do have an obligation to our guests. In this spirit, we appreciate your honest answers to the following questions:

Have you ever been convicted for a sex offense? YES NO

If yes, what was the nature of the charge and when did this happen?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Have you ever been convicted of a crime that involved violence? (circle please) YES NOIf yes, what was the nature of the charge and when did this happen? ____________________________________________________________________________________________________________________________________________________________________________________________________

The reputation of our recovery center hinges on the community’s perceptions of the center and those involved with it. With that in mind, are there any other charges or convictions from your past that we should be aware of? YES NO (circle please)

If yes, what was the nature of the charge and when did this happen?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

I acknowledge and affirm that the information provided in this application is Honest, complete and accurate:

Signature ____________________________________________________

Please print your name here______________________________________ Date _____________________35

Grievance Form

Date: Name: Phone: Email: Hope center involved: __ Manchester __ Franklin __Berlin __ Emergency Department Program Hospital name: __ Other: Does this grievance have to do with a staff person at HOPE? YES NO (please circle one) Name of Staff Involved: (if any) Date of issue causing grievance: Is this a confidentiality breach grievance? YES NO (please circle one)Is this a center protocol issue? YES NO (please circle one)Nature of grievance:

Date Reviewed:

Review committee present:

Resolution:

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Center Manager Sign Print NameRevised 1/22/18

Member ConsentCONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE MEMBER RECORDS

The confidentiality of member records maintained by this program is protected by Federal law and regulations. Generally, the program may not say to a person outside the program that a member attends the program, or disclose any information identifying a member as an alcohol or drug abuser unless:

The member consents in writing; OR The disclosure is allowed by a court order; OR The disclosure is made to medical personnel in a medical emergency or to a qualified personnel for

research, audit, or program evaluation; OR The member commits or threatens to commit a crime either at the program or against any person

who works for the program.

Violations of the federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs. Federal law and regulations do not protect any information about suspect child abuse or neglect from being reported under state laws to appropriate state or local authorities.(See 42 U.S.C. Sec. 290dd-2 for Federal law and 42 CFR Port 2 for Federal regulations.) Legal Action Center. (1996) Handbook on legal issues for school based programs (revised). Pp 71, 72, & 74. New York: Author.

CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

I , authorize HOPE FOR NH to disclose the following information for Member name

activities / services to for the following time periodName of agency information is being consented to

to Intake Date 6 months from intake date

Signature of Member: Date:

Consented Information Recovery Plan- - Consent Voucher Information ReportMember Information Profile Encounter Detail Continuing Care Planning

Other Disclosures I understand that my records are protected under federal regulations governing Confidentiality if Alcohol and Drug Abuse member Records, 42 CFR Part 2, and the Health Insurance Portability and Accountability Act of 1996 (HIPPAA), 45C.F.R. Pts.

37

160 & 164 and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time except to the extent that action has been taken in reliance on it, and that in any event this consent expires automatically as indicated with each disclosure item above. I understand that generally HOPE FOR NH may not condition my treatment on whether I sign a consent form, but that in certain limited circumstances I may be denied treatment if I do not sign consent form.

Attachment B.2 (Revised on 7/5/2016)

Membership Form

*This form must be completed with a HOPE for NH Recovery Staff Member or Volunteer

Staff Initials: Center: Date:

Name: D.O.B. _ _ / _ _ / _ _ _ _ Gender: M ☐ F☐ T☐ Address: City: State: Zip: Email: Phone: Emergency Contact: Phone: Referred from: Friend ☐ Family ☐ Workplace Initiative ☐ Criminal Justice System ☐ Emergency Services ☐

Mental Health Provider ☐ Treatment ☐ Primary Care Provider ☐ Self ☐Are you employed? Yes ☐ No ☐ Looking ☐ Employer:

Would you like Telephone Recovery Support Services (TRS)? Yes ☐ No ☐ I prefer to receive Text ☐ Phone Call

☐

What is your current living situation? Homeless ☐ With Family ☐ Independent Living ☐ Recovery Housing ☐

Residential Treatment ☐ Rent☐ Own ☐ Incarcerated☐

Are you a Home Comer (re-entering from Dept. of Corrections)? Yes ☐ No ☐

Do you have Health Insurance? Yes ☐ No ☐

Anthem BC/BS ☐ Minuteman ☐ Tufts ☐ Matthew Thornton ☐ Mass Health ☐ Other:

Primary Language:

What are you using for support now? Mutual Aid ☐ Mental Health Services ☐ Medication Assisted Treatment ☐

Recovery Coaching ☐ Counseling (LADC) ☐ Faith Based Group ☐ Physical Activities ☐ None ☐Have you been to treatment? Yes ☐ No ☐ How many times?

What is your primary Addiction? Alcohol ☐ Prescription Drugs ☐ Marijuana ☐ Heroin ☐ Cocaine ☐

Methamphetamines ☐ Hallucinogens ☐ Poly Use ☐ Nicotine ☐What is your Secondary Addiction? Alcohol ☐ Prescription Drugs ☐ Marijuana ☐ Heroin ☐ Cocaine ☐

Methamphetamines ☐ Hallucinogens ☐ Poly Use ☐ Nicotine ☐

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What is your Addiction Wellness Status? Survivor☐ In Recovery☐ Medication Assisted Recovery☐

Active User☐ Currently Struggling☐

What is your Treatment/Counselling Status? IOP☐ In Treatment☐ In Recovery☐ Active Counseling☐ None ☐Are you a parent? Yes ☐ No ☐ Number of children: Number living with you: _____

If they are not living with you, is there a reunification plan in place? Yes ☐ No ☐

Are you in the Military? Yes ☐ No ☐ Are you a Military Veteran? Yes ☐ No ☐

Race, Ethnicity and Household Data: Please provide the number of all persons applying to participate in this program next to appropriate race(s) (count all that apply) and ethnicity characterization, and check the household characterization(s) that apply. A number of different categories may apply; please mark all that apply.

Income level? Please choose the row that represents your family size and circle the family household income** range in the same row.

Number of persons in family Family income range Family income range Family income range Family income range

↓ ↓ ↓ ↓1 Person → $0 – $16,450 $16,451 – $27,450 $27,451 – $43,900 $43,901+2 Persons → $0 – $18,800 $18,801 – $31,400 $31,401 – $50,200 $50,201+3 Persons → $0 – $21,150 $21,151 – $35,300 $35,301 – $56,450 $56,451+4 Persons → $0 – $24,600 $24,601 – $39,200 $39,201 – $62,700 $62,701+5 Persons → $0 – $28,780 $28,781 – $42,350 $42,351 – $67,750 $67,751+6 Persons → $0 – $32,960 $32,961 – $45,500 $45,501 – $72,750 $72,751+7 Persons → $0 – $37,140 $37,141 – $48,650 $48,651 – $77,750 $77,751+8 Persons → $0 – $41,320 $41,321 – $51,750 $51,751 – $82,800 $82,801+

**Note: Family household income includes wages and salaries, interest, net business income, social security, pensions, alimony received, VA benefits and educational benefits received by all family m e m b ers living in t he hous e ho ld . Alimony paid may be deducted.

For example: A family of 3 with a family income of $33,655 would be represented as:NUMBER OF PERSONS FAMILY INCOME

IN FAMILY RANGE FAMILY INCOME RANGE FAMILY INCOME RANGE FAMILY INCOME RANGE↓ ↓ ↓ ↓

3 Persons → $0 – $20,400 $20,401 – $34,000 $34,001 – $54,400 $54,401+☐ I have received a copy of the membership agreement, and I agree to the terms of the membership of the HOPE for NH Recovery Centers.

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RACE ETHNICITY # White

# Hispanic or Latino

# Black/African American # Asian # American Indian/Alaskan Native # Native Hawaiian/Other Pacific Islander # American Indian/Alaskan Native & White # Asian & White # Black/African American & White

# American Indian/Alaskan Native & Black/African American # Asian/Pacific Islander # Other Multi-Racial_

☐ I am certifying I am at least 18 years of age and understand and agree to the following statement:By consenting to provide your e-mail address you are giving HOPE for NH Recovery permission to contact you through e-mail with any upcoming events, Telephone Recovery Support, or Peer Recovery Coaching.

☐ I understand photographs are not taken during recovery meetings. HOPE for NH Recovery uses social media, i.e. Facebook, Twitter, etc., extensively to promote special events and HOPE Recovery Community Centers in general. HOPE does their best to announce to members when pictures are taken.

Member’s Signature: Date:

Statement of Confidentiality Form

All information concerning current or former recovering individuals, financial data, and business records of HOPE for NH Recovery is confidential. “Confidential” means that you are not permitted to disclose recovering individuals’ names or talk about them in ways that will make their identity known or divulge financial data or business records. No information may be released without appropriate authorization. This is a basic component of business ethics. Board members, staff and volunteers must conform to this rule of confidentiality.

HOPE expects you to respect the privacy of all recovering individuals. All records dealing with recovering individuals must be treated as confidential. General information, policy statements or statistical material is not classified as confidential.

Failure to maintain confidentiality by board members, staff or volunteers may result in removal, termination, or other corrective action. This policy is intended to protect you as well as HOPE because in extreme cases, violations of this policy also may result in personal liability.

Rationale:Confidentiality is the preservation of privileged information. By necessity personal and private information is disclosed in a professional working relationship. Part of what you learn is necessary to provide services to the individual; other information is shared within the development of a trusting relationship. Therefore, most information gained about an individual is confidential in terms of the law, and disclosure could make you legally liable. Disclosure could also damage your relationship with the individual and make it difficult to help the person.

Before you begin your assignment as a board member, staff member or volunteer, you should be aware of the laws and penalties for breaching confidentiality. HOPE for NH Recovery is liable for your acts within the scope of your duties, giving information to an unauthorized person could result in the HOPE's refusal to support you in the event of legal action. Violation of the state statutes regarding confidentiality of records is punishable upon conviction by fines or by imprisonment or by both.

Certification

I have read HOPE's policy on Statement of Confidentiality as presented above. I agree to abide by the 40

requirements of this policy and inform my supervisor immediately if I believe any violation (unintentional or otherwise) of the policy has occurred. I understand that violation of this policy may lead to disciplinary action, up to and including termination of my service with HOPE for NH Recovery.

Print Name:

Member’s Signature: Date:

Code of Ethics Statement

CONDUCT We will be courteous, truthful, respectful and friendly at all times. Our actions dictate how the community

sees the recovery community. We will strive to maintain a safe, clean and sober environment. We will be loyal, honest and respectful to ourselves and others. We will resist the use of profanity and spreading gossip or rumors. We will not bring drugs, paraphernalia or weapons into the recovery center or to any activity associated with

the recovery center.

RESPONSIBILITY TO PEOPLE IN RECOVERY We will be generous - remembering where we come from and that people can change. We will respect one another's definition of "Recovery". We will work hard to assist one another to move forward in recovery. We will treat one another with unconditional love, kindness, patience and honesty. We will be willing to lend a hand to help a new comer whenever possible.

RESPONSIBILITY TO THE RECOVERY CENTER We will be receptive and responsive to needs of the Recovery Center. We will contribute by taking part in meetings, activities and the participatory process as we know this is vital to

our recovery. We will encourage members to volunteer. We will keep the center clean and organized. We will take on the responsibility of maintaining a safe, clean and sober environment.

RESPONSIBILITY TO THE COMMUNITY We will strive to be productive and respectful members of our society. We will be committed to helping people in the community at large, not only those in recovery. We vow to be law abiding citizens within our society. We will be aware of the positive impact of our good deeds can have on the community, the Recovery Center

and ourselves. We will perform random acts of kindness no matter how small they seem, showing the community who we are

41

and why we are here. We will work towards educating the

community further with the intent of changing the stigma associated with addictions.

Member’s Signature: Member #:

Encounter Form

Contact type: □ Group session □ Telephone Support □ In person session □ IntakeSite: Start time: Stop time: Total Units:

□ Doing well making headway on current goal(s). Goal:______________________________________

□ Began a new program/job/training. Detail: __________________________________________

□ Continued a program/job/training Detail: __________________________________________

□ Completed a program/training Next steps: __________________________________________

□ Maintained recovery plan __________________________________________

□ Changed plan (positive) (not positive) __________________________________________

□ Stopped working on plan goals __________________________________________

□ Struggling but no Reoccurrence □ Struggling and Reoccurrence Date ______________

Referred to Treatment Y□N□ Date: ________Location: ________________Type/facility__________________Notes:

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Date

Member Name

Member #

Insurance Co.

Insurance #

If no insurance, License #

________________________________________________________________________________________Signature of Coach Date________________________________________________________________________________________Printed Name of Coach

Recovery Plan

Member Name: __________________ Member #: Plan Date: Original Plan ☐ Revisiting Plan ☐

What is my overall recovery goal(s)? (chose all that apply)☐ Maintain recovery “one day at a time” ☐ Detox ☐ Learn more about mutual aid groups

☐ Reunify with family ☐ Treatment ☐ Gain employment

☐ Reunify with children ☐ Intensive Outpatient Treatment ☐ Get training/schooling

☐ Maintain probation requirements ☐ Recovery housing ☐ Complete community service

☐ Rectify legal issues ☐ Other:

Strengths I have to help me maintain recovery:☐ Family / relationship support ☐ No criminal history ☐ Attend all treatment appointments

☐ Job experience ☐ Currently employed ☐ Attend 12 step or other peer support groups

☐ No legal issues ☐ Has transportation ☐ Stable housing

☐ Taking medication as prescribed ☐ Prior history of recovery ☐ Financial stability

☐ Primary Care Physician ☐ Medication Assisted Treatment:

☐ Other:

Barriers I need help in my recovery:☐ No transportation ☐ No job ☐ Not connected with substance abuse

treatment

☐ Current legal issues / parole/probation / DCYF ☐ Financial issues ☐ Untreated health condition(s)

☐ No / unstable housing ☐ No / minimal supports ☐ Not connected to mental health treatment

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☐ Criminal history ☐ No primary care doctor ☐ Unstable family / relationship support

☐ Education ☐ Other:

Steps I need to take to meet my recovery goal(s):

☐ By checking this box on this plan, I understand that services I receive for recovery coaching will be maintained by the HOPE Manchester Center in an electronic health record. If I am a current HOPE Manchester Center member, my recovery plan will become part of my HOPE Manchester Center electronic health record. I acknowledge and agree to store my recovery plan and other documentation collected as part of my recovery services with The HOPE Manchester Center.

Coach:

Social Media Policy Compliance Form

This policy provides guidance for employee use of social media, which should be broadly understood for purposes of this policy to include blogs, wikis, microblogs, message boards, chat rooms, electronic newsletters, online forums, social networking sites, and other sites and services that permit users to share information with others in a contemporaneous manner.

The following principles apply to professional use of social media on behalf of Hope for NH Recovery as well as personal use of social media when referencing Hope for NH Recovery, its centers, and/or any events:

Employees need to know and adhere to Hope for NH Recovery’s Code of Conduct, Employee Handbook, and other company policies] when using social media in reference to Hope for NH Recovery.

Employees should be aware of the effect their actions may have on their images, as well as Hope for NH Recovery’s image. The information that employees post or publish may be public information for a long time.

Employees should be aware that Hope for NH Recovery may observe content and information made available by employees through social media. Employees should use their best judgment in posting material that is neither inappropriate nor harmful to Hope for NH Recovery, its employees, or customers.

Although not an exclusive list, some specific examples of prohibited social media conduct include posting commentary, content, or images that are defamatory, pornographic, proprietary, harassing, libelous, or that can create a hostile work environment.

Employees are not to publish, post or release any information that is considered confidential or not public. If there are questions about what is considered confidential, employees should check with the Human Resources Department and/or supervisor.

Social media networks, blogs and other types of online content sometimes generate press and media attention or legal questions. Employees should refer these inquiries to authorized Hope for NH Recovery spokespersons.

If employees encounter a situation while using social media that threatens to become antagonistic, employees should disengage from the dialogue in a polite manner and seek the advice of a supervisor.

Employees should get appropriate permission before you refer to or post images of current or former employees, members, vendors or suppliers. Additionally, employees should get appropriate permission to use a third party's copyrights, copyrighted material, trademarks, service marks or other intellectual property.

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Social media use shouldn't interfere with employee’s responsibilities at Hope for NH Recovery. Hope for NH Recovery computer systems are to be used for business purposes only. When using Hope’s computer systems, use of social media for business purposes is allowed (ex: Facebook, Twitter, Hope blogs, and LinkedIn, but personal use of social media networks or personal blogging of online content is discouraged and could result in disciplinary action.

Subject to applicable law, after hours online activity that violates Hope for NH Recovery ‘s Code of Conduct or ‐any other company policy may subject an employee to disciplinary action or termination.

If employees publish content after hours that involves work or subjects associated with Hope for NH Recovery, a‐ disclaimer should be used, such as this: “The postings on this site are my own and may not represent Hope for NH Recovery positions, strategies or opinions.”

It is highly recommended that employees keep Hope for NH Recovery related social media accounts separate from personal accounts, if practical.

_____________________________________________________ ____________________Employee Signature Date

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Training Effectiveness Evaluation Form

Date: ___________________________ Course Title: _____________________________________________________

Name: _____________________________________ Trainer: ______________________________________________(Optional)

How would you rate the overall quality of this instruction? ☐Excellent ☐Good ☐Fair ☐Poor

How well did the presenter state the objectives? ☐Excellent ☐Good ☐Fair ☐Poor

How well did the presenter keep the session alive and interesting? ☐Excellent ☐Good ☐Fair ☐Poor

What is your overall rating of the presenter? ☐Excellent ☐Good ☐Fair ☐Poor

How well did this program accommodate your background and needs? ☐Excellent ☐Good ☐Fair ☐Poor

How effective were the handouts? ☐Excellent ☐Good ☐Fair ☐Poor

How convenient was the location? ☐Excellent ☐Good ☐Fair ☐Poor

What was the most interesting thing you learned in this course?

What was the least interesting thing you learned in this course?

Was the length of the presentation sufficient for the topic? (Explain)

What would have made the session more effective?

The knowledge and skills I gained from this program will be useful in my job? ☐ Yes ☐ No

If YES, then list one item from the training that you are going to implement or review when you return to work.

What other training sessions would you like Hope for NH Recovery to provide?

Additional Comments:

Please complete and return to Hope for NH Recovery Staff

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Policies and Procedures Manual Acknowledgement Signature Form

The Policies & Procedures Manual describes important information about The HOPE for NH Recovery organization and I understand that I should consult the Center Manager or Executive Director regarding any questions not answered in this Handbook.

Since the information, policies, procedures and benefits described herein are subject to change. I acknowledge the revisions to this Handbook may occur. I understand that revised information may supersede, modify, or eliminate existing policies or procedures. Only the Board of Directors has the ability to adopt any revisions to the policies in this Handbook.

Furthermore, I acknowledge that this manual is neither a contract of employment nor a legal document. I have reviewed this manual and I am aware of its location should I need to access it in the future. I understand and acknowledge that it is my responsibility to read and comply with the policies contained in this manual and any revisions made to it.

I have read and understand the Hope for NH Policies and Procedures Manual:

Signature Date

Printed Name Center

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