Interested in joining the Employee Fitness Center?

Transcription

1 Interested in joining the Employee Fitness Center? To get started just download the 4 forms located on the Employee Wellness Link, read them, sign them and return them to Employee Health. Forms may also be picked up at the Employee Health office. If you answer no to all questions asked on the Physical Activity Readiness Questionnaire, please do the following: IMPORTANT! If you answer yes to any questions asked on the Physical Activity Readiness Questionnaire, please do the following: Bring signed forms back to Employee Health. Once the signed forms are returned to Employee Health, Security will be notified that you may have badge access to the Fitness Room. Actual access may take up to 2 business days. You will need to use your FMH badge to gain access to the Fitness Room (Cardiac Rehab). Physician approval is required. Please see your personal physician for medical approval. Your physician must sign off on the Physical Activity Readiness Questionnaire before you can use the Fitness Room. Bring signed copy of Physical Activity Readiness Questionnaire to Employee Health. If your physician has approved Unsupervised Medical Program option you can begin use of the Fitness Room. If Medically Supervised Exercise option was chosen, you will be referred to the FMH Medical Fitness Program located at the YMCA. Once the signed forms are returned to Employee Health, and your physician has approved your ability to join the unsupervised medical program, security will be notified that you may have badge access to the Fitness Room. Actual access may take up to 2 business days. You will need to use your FMH badge to gain access to the Fitness Room (Cardiac Rehab).

2 Frederick Memorial Healthcare System Fitness Program Membership Agreement, Legal Liability Waiver and Informed Consent Hours of Operation: Tuesday, Thursday, Saturday and Sunday: 24 hours unlimited Monday, Wednesday and Friday: 7:30p.m. - 6:30a.m. Space not available Monday, Wednesday and Friday 6:30 am 7:30 pm due to patient care. Fitness Center Rules: The following rules govern the use of the Fitness Center. Violation of these rules may result in the loss of membership and the privilege of use of the center. 1. The center is open and available for member use based on authorized access given to the employee through their badge. 2. Employees who are authorized users of the Fitness Center may not allow non-members to use the facility. Members should not knowingly let unauthorized individuals into the facility. 3. Use of the equipment at the Fitness Center is at your own risk. 4. Any damage, broken parts or other problems with the equipment should be promptly reported to the Cardiac Rehab staff at extension Users of the equipment are responsible for the proper and safe use of the equipment. Users must wear appropriate athletic shoes when using treadmills, cross trainers or like equipment. 6. Each user of the equipment is responsible for cleanup after himself or herself. Any perspiration left on machine contact surfaces should be cleaned off after use of the machine. The center will maintain access to approved disinfectant cleanser and paper towels for cleaning. 7. The Fitness Center is situated within Frederick Memorial Hospital. Conduct while using the Fitness Center shall conform to all FMH Human Resource policies. 8. The equipment in the Fitness Center is shared equipment; therefore users should limit their use of the aerobic equipment to thirty minutes. Saving or holding equipment for later use is not allowed. 9. Lockers are provided for temporary storage of street/work clothes, as well as showers and dressing areas. Employees are encouraged to lock all

3 personal items up while exercising. Overnight storage of personal items in the lockers is not allowed. I acknowledge that I have read the rules, noted above, governing the use of the Fitness Center and I agree to abide by them. I voluntarily agree to waiver liability for any injury I sustain through or while utilizing the equipment and programs of the Frederick Memorial Healthcare System Employee Fitness Center. I further acknowledge that my participation and use of the fitness equipment or other activities associated with the Fitness Center is being done voluntarily and of my own desire and that participation in or use of the Fitness Center is not a requirement for my job. Print Name: Department: Signature: Date:

4 EXPLANATION OF THE EMPLOYEE FITNESS PROGRAM The primary goal of the Employee Fitness Program is to help improve your health and well being. This is a self-monitored, non-supervised program. MONITORING This is an unsupervised program, in which you accept responsibility for yourself, and exercise at your own risk. Should you desire medical monitoring, please inquire about the FMH Medical Fitness Program, located at the YMCA building. Security camera s monitor the use of the facility at all times. Employees are asked to remain alert and contact security with any concern for their safety. Employees are strongly encouraged to leave valuables in a locked area. ACCESSORIES Showers are available for use, but employees must bring their own towels, soap and shampoo if desired. USE OF MEDICAL RECORDS The information obtained during the initial assessment and while you are a participant in the Employee Fitness Program will be privileged and confidential. It will not be released or revealed to any person except your physician(s) without your written consent. The information obtained, however, may be used for statistical analysis or scientific purpose with your right to privacy retained. RULES AND REGULATIONS I have received a copy of the program rules and regulations. I realize that I am liable if I choose to not follow any part of them. I acknowledge that I have read this form in its entirety or it has been read to me, and that I understand the Employee Fitness Program in which I will be engaged. I accept the rules and regulations set forth. I consent to exercise unsupervised in this facility at my own risk. Participant s Signature Date

5 WAIVER FOR EMPLOYEE FITNESS IN DEPARTMENT OF PREVENTIVE CARDIOLOGY AND REHAB I understand that when exercising in the department of Preventive Cardiology and Rehab on the Main Campus at Frederick Memorial Hospital, as an Employee Fitness member, I will be exercising at my own risk in an unsupervised environment. I am aware that Frederick Memorial Healthcare Systems is not responsible, in the event of any injury or incident that takes place while I am exercising in this facility. Employee Name (signed) Date Employee Name (printed) Witness Name (signed) Witness Name (printed) Date