Volunteer Hours Report Form

Please correct the errors described below.

CASCADE HEALTH HOSPICE

Volunteer Name:

Direct Patient Care Support Hours (Hospice & Palliative)

*includes phone call and travel time

Bereavement Support Hours

*includes phone call and travel time. Use this box after patients demise for phone calls & family visits

Patient first name last initial & ID

Example PreetiF100000000

Total Mileage Covered

Only for direct patient care volunteers

Administrative/Office Hours

*Hospice related administrative activities

Events Volunteering Hours

Pete Moore Hospice House Support

*Includes administrative & patient care hours

Trainings/In-services

Eugene Threshold Singers

Community Group Response Volunteers

Other Projects

e.g. Events, Arranging flowers, tabling etc.

Yard/Garden Maintenance for patients and families

Community Group Response Volunteers

General Cascade Health Volunteer Hours

*Palliative packets, Home Health packets, other projects

Please enter total time by category here:

Service Date:

Start Time:

End Time:

Service provided:

E.g. 1. Visited PreetiF1000000 (ID Number is 8 digit) lovely visit with her. She......

Please submit a new form for each activity.

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CASCADE HEALTH HOSPICE

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