Volunteer Log Sheet

Please submit this form after each conversation with client/caller or 3rd unsuccessful attempt to make contact. Click here for PDF version.

    Mentoring Date:

    Your Name (required):

    Phone:

    Your Email (required):

    Client Information:

    Client/Caller's Name:

    Phone:

    Best Time(s) to Call:

    Client Email:

    Prefers to be contacted by:

    Email communication is acceptable, but communicating by telephone is a more effective form of mentoring. If possible, try to set up a phone appointment with the person you are mentoring.

    Name(s) of loved One(s):

    Relationship / Age(s):

    Air Carrier / Flight Number:

    Call / Email Log:

    Date / Time:

    Attempted Contact by:
    PhoneEmail

    Notes:

    Date / Time:

    Attempted Contact by:
    PhoneEmail

    Notes:

    Date/Time:

    Attempted Contact by:
    PhoneEmail

    Notes:

    Summary of Client / Caller's Response

    Thoughts / Feelings:

    What was the focus of the call?

    His/Her available support systems:

    Your Assessment:
    Doing as well as can be expected
    Concerned about his/her mental state (if so, explain below)

    Additional Comments or Concerns:

    Your Next Step:
    Follow up callFollow up email
    To be made on:

    Information / Referral Requested (explain):

    Thank you for being a Volunteer Grief Mentor.
    You are the heart of ACCESS!

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    You may also fill out this form and mail it in.

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    Families We Have Helped:

    Below are some of the air disasters that we have responded to:
    Private Plane - 9/26/12
    Rockingham County, VA
    Private Plane - 2/27/11
    Abu Dhabi
    Private Plane - 12/22/10
    Barrington, NY
    Private Plane - 7/17/10
    South Portland, ME
    Air India Express 812 - 5/22/10
    Mangalore, India
    Afriqiyah Airways 8U771- 5/12/10
    Tripoli, Libya
    Ethiopian Airlines 409 - 1/25/10
    Off of Na'ameh, Lebanon
    Air France Flight 447 - 6/1/09
    Atlantic Ocean
    Turkish Airlines Flight 1951 - 2/25/09
    Amsterdam Airport Schiphol
    Continental Flight 3407 - 2/12/09
    Clarence Center, NY
    US Airways Flight 1549 - 1/15/09
    Hudson River, NY
    Aeroflot Flight 821 - 9/14/08
    Perm, Russia
    Spanair JK 5022 - 8/20/08
    Madrid, Spain
    TAM Airways JJ 3054 - 7/17/07
    São Paulo, Brazil
    Comair Flight 5191 - 8/27/06
    Lexington, KY
    Airbus A320-211 - 5/3/06
    Off Sochi, Russia
    Bellview Airlines - 10/23/05
    Nigeria
    West Caribbean Airways 708 - 8/16/05
    Machiques, Venezuela
    Air France Flight 358 - 8/2/05
    Ontario, Canada
    Kam Air Flight 904 - 2/3/05
    Pamir Mountains, Afghanistan
    Corporate Airlines 5966 - 10/19/04
    Pettis Township, MO
    Kish Airlines Flight 1770 - 2/10/04
    United Arab Emirates
    Georgian Express Flight 126 - 1/17/04
    Ontario, Canada
    Flash Airlines 604 - 1/3/04

    Red Sea

    Turkish Airlines 634 - 1/8/03

    Diyarbakır Airport, Turkey

    US Airways Express/Air Midwest Flight 5481 - 1/8/03

    Charlotte, NC

    American Flight 587 - 11/12/01

    Queens, NY

    The events of September 11, 2001

    Private Plane - 12/3/00
    Milltown, WI
    Singapore Airlines 006 - 10/31/00

    Chiang Kai-shek Internat'l Airport

    Gulf Air Bus A320 - 8/23/00

    Persian Gulf, Bahrain

    Air France Concorde 4590 - 7/25/00

    Gonesse, France

    Alaska Airlines 261 - 1/31/00

    Pacific Ocean

    Egypt Air 990 - 10/31/99

    Atlantic Ocean

    American Airlines 1420 - 6/1/99

    Little Rock, AR

    Swissair 111 - 9/2/98

    Atlantic Ocean

    Private Plane - 8/4/98
    Phillips, WI
    TWA 800 - 7/17/96

    US Air 427 9/8/94

    Allegheny County, PA

    Long Island, NY

    Pan Am 103 - 12/21/88

    Lockerbie, Scotland

    TWA/United Airlines - Mid-Air Collision- 12/16/1960
    Brooklyn & Staten Island, NY
    and hundreds of other private, commercial and military air disasters

    See Full List