Volunteer's Name* First Last Date* MM slash DD slash YYYY Bereaved #* Arrival Time* : Hours Minutes AM PM AM/PM Departure Time* : Hours Minutes AM PM AM/PM Total Time (including travel)*Miles Traveled*Type of Contact Phone/cards In person Meeting Funeral/visitation Candle delivery Emotions Appropriate Little/none shown Overwhelmed Anger Other Physical No change Exhaustion/fatigue Sleeping/eating changes Other Social Good supports Some social activities Seeking contact Lacks support Avoiding contact with others Plan for Follow-Up: Phone calls Monthly contact per BE staff 2,3,6,9,12 month contacts, including special dates Encouraging grief group attendance Notes/cards Anniversary visit Confer with BE staff Other Narrative/Comments (optional)CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
