Volunteer Time Sheet printable pdf download

Volunteer Time Sheet

Month:________________________

Year:_____

Volunteer Name:______________________________________

Time spent, services provided, and miles driven on behalf of Eastside Friends of Seniors clients is not only greatly

appreciated but is required information for grant applications and audits.

Record each activity by date and each activity on a separate line. Round hours and miles to .25

No hours to report? Check here: ______

DATE

CLIENT'S NAME

SERVICE(S) PROVIDED

MARK EACH BOX BELOW THAT APPLIES TO YOUR CLIENT(s) IN THIS REPORTING MONTH:

 Doing fine, no significant changes

 Had a dramatic change in health (Describe:

)

 Showing increased need for help (Describe:

)

 Went/was admitted to a hospital (for:

)

 Moved to a family member's home, an adult family home, an assisted living facility, or a skilled nursing home

 Yes

 No

MAY WE CONTINUE YOU ON ACTIVE STATUS?

Comments:

PLEASE COMPLETE THIS FORM AND SEND BACK BY THE 5

OF THE MONTH VIA E-MAIL TO:

Volunteer Time Sheet