Volunteer Grief Mentor Log Sheet

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

Terms of Volunteer Grief Mentoring

Please fill out this form after each contact with the client you are mentoring or after the 3rd unsuccessful attempt to make contact.

Date:
Your Name:
* Your Email:
Client/Caller Name:

Call/Email Log:
1st Attempt	Date:			Time:			Phone    Email
Notes on contact attempt:
2nd Attempt	Date:			Time:			Phone    Email
Notes on contact attempt:
3rd Attempt	Date:			Time:			Phone     Email
Notes on contact attempt:
Summary of Client/Caller Response: Thoughts/Feelings Expressed:
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 (please explain):
Additional Comments/Concerns:
Your Next Step:
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.
Follow-up Call Follow-up Email To be made on: Information/Referral Requested (explain):
* To submit this form, please enter the characters you see in the image:
Thank you for being a Volunteer Grief Mentor. You are the heart of ACCESS!