Home › Volunteer Grief Mentor Log sheet

Volunteer Grief Mentor Log sheet

For ACCESS Volunteer Grief Mentors only:
Please fill out this form after each contact with the client you are mentoring or after the 3rd unsuccessful attempt to make contact.

Click here to download the PDF version of the Log Sheet.

Terms of Volunteer Grief Mentoring

    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!

    Enter This Code
    captcha