Community Visitor Scheme Quarterly Reporting (January 2019–March 2019)

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* 1. Your name

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* 2. Name of Aged Care Home

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* 3. What period are you reporting on?

Jan – Mar

April – June

July – Sept

Oct – Dec

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* 4. How many times have you visited your resident in the last 3 months? (Or if you prefer, please list the dates).

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* 5. If you were unable to visit each fortnight, please provide reasons and any alternative forms of communication (e.g. holiday – postcard was sent).

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* 6. Are there any issues/comments/stories that you would like to share?

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* 7. Has your contact details changed in the last 3 months? If yes, please provide an update.