VOLUNTEER GUARDIAN - MONTHLY ACTIVITY LOG  

       MONTH / YEAR

(Use tab to navigate from field to field  - the enter button acts as submit and should be used only when form is completely filled in.)

CLIENT NAME:                               VOLUNTEER NAME:
                             CLIENT/PERSON            PHONE # OR                  PURPOSE OF CONTACT &                  CASE
:DATE TYPE *                  CONTACTED              E-MAIL ADDRESS                OBSERVATIONS                             TIME   MILEAGE
    
     
     
     
     
     
     
     

                                                                                                                    MONTHLY

  TOTALS -   MINUTES:    MILES:

*Key V= Face-to-face visit with client            

           P= Phone call

          O= Other

          S=  Support/Training

**ENTER IN MINUTES

(EXAMPLE 2 HOURS = 120

                  

Do you want reimbursement for mileage and other expenses? Yes or No               

Other expenses: (postage, copying, parking, etc.) $

                              Reimbursement requests must be received on the 4th day of the month in order to be compensated.

STATUS OF CLIENT MONTHLY SUMMARY

 

                                                                                                        MONTH/YEAR

 

Describe activities in which client participates.

 

 Describe any changes / concerns in your client's physical condition. 

 

 

Describe any changes / concerns in your client's mental condition?

 

Do you feel current placement meets clients\'s needs?                 

If no, give details. 

Would you like to discuss this matter with your case manager?  

On a quarterly basis, request printouts of your client's trust fund that includes deposits and expenses.  Do you have any concerns about any unusual expenditures? 

Please describe.

Copyright © 2003 Guardianship Services, Inc.. All rights reserved.
Revised: August 12, 2008