Volunteer Helping Hands - Volunteer Service Log
Please complete one log for each visit

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1. Volunteer (Required.)

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2. Client (First name, Last initial) (Required.)

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3. Date of Contact (Required.)

Date of Visit or Virtual Contact

Date

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4. Type of Contact (Required.)

In-Person

Virtual (Phone or Zoom)

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5. Please share a bit about your visit with the client, caregiver or family. REMINDER: Your stories are the most important part of your log! Please don't leave this blank. (Required.)

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6. Total Mileage (Mileage to and from client AND during visit. Use numbers only.)

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7. Activities:
Please list the total # of hours spent on each task during this visit. (Please round to nearest half hour. Use numbers only.) (Required.)

Companionship/Friendly Visits

Help around the house (i.e. laundry, chores)

Running errands (i.e. grocery shopping, pharmacy)

Home Repair/Maintenance

Meal Preparation/ Serving

Resource sharing/referrals

Complementary services/stress reduction (i.e. massage, Reiki, mindfulness, music)

Transportation (while with the client - i.e. doctors appointment, treatment)

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8. Total Visit Hours (add up hours from q. 7. Use numbers only.) (Required.)

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9. If you provided transportation, please specify to and from what services

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10. Were you relieving a family caregiver who would usually perform these activities? (Required.)

Yes

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11. Is this caregiver/family in need of additional support? (Required.)

Yes, please describe

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12. Was there a decline in the client's status from your last visit? (Required.)

Yes, please describe

Volunteer Helping Hands - Volunteer Service LogPlease complete one log for each visit

Question Title

* 1. Volunteer (Required.)

Question Title

* 2. Client (First name, Last initial) (Required.)

Question Title

* 3. Date of Contact (Required.)

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* 4. Type of Contact (Required.)

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* 5. Please share a bit about your visit with the client, caregiver or family. REMINDER: Your stories are the most important part of your log! Please don't leave this blank. (Required.)

Question Title

* 6. Total Mileage (Mileage to and from client AND during visit. Use numbers only.)

Question Title

* 7. Activities:Please list the total # of hours spent on each task during this visit. (Please round to nearest half hour. Use numbers only.) (Required.)

Question Title

* 8. Total Visit Hours (add up hours from q. 7. Use numbers only.) (Required.)

Question Title

* 9. If you provided transportation, please specify to and from what services

Question Title

* 10. Were you relieving a family caregiver who would usually perform these activities? (Required.)

Question Title

* 11. Is this caregiver/family in need of additional support? (Required.)

Question Title

* 12. Was there a decline in the client's status from your last visit? (Required.)

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* 13. Volunteer Travel Time (time to and from client, NOT travel time during visit)

Volunteer Helping Hands - Volunteer Service Log
Please complete one log for each visit

1. Volunteer (Required.)

2. Client (First name, Last initial) (Required.)

3. Date of Contact (Required.)

4. Type of Contact (Required.)

5. Please share a bit about your visit with the client, caregiver or family. REMINDER: Your stories are the most important part of your log! Please don't leave this blank. (Required.)

6. Total Mileage (Mileage to and from client AND during visit. Use numbers only.)

7. Activities:
Please list the total # of hours spent on each task during this visit. (Please round to nearest half hour. Use numbers only.) (Required.)

8. Total Visit Hours (add up hours from q. 7. Use numbers only.) (Required.)

9. If you provided transportation, please specify to and from what services

10. Were you relieving a family caregiver who would usually perform these activities? (Required.)

11. Is this caregiver/family in need of additional support? (Required.)

12. Was there a decline in the client's status from your last visit? (Required.)

13. Volunteer Travel Time (time to and from client, NOT travel time during visit)