Community Visitor Scheme Feedback Name of Volunteer:* First Name Last Name Phone Number: Name/s of volunteer partners* Write N/A if not applicable I volunteer as part of* Ohel Chana YLiV Yeshivah Gedolah DaMinyan None of the Above Name of senior currently visiting: Name of aged care home* write N/A if not applicable Date of visit and time arrived:* Day Month Year 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Time left:* 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM Type of Visit* Group One-on-one Phone Call Email How many people did you visit?* Please outline any highlights of your visit From a scale of 0 to 5, please rate your experiences: I feel there is adequate communication between myself and the senior I am visiting: 0 1 2 3 4 5 The time of my visits fit with this person's daily schedule: 0 1 2 3 4 5 I feel I make a difference to this person's life: 0 1 2 3 4 5 I feel there is more we can do for this person: 0 1 2 3 4 5 I feel I have gained by visiting the elderly: 0 1 2 3 4 5 I enjoy giving of my time to visit the elderly: 0 1 2 3 4 5 Please elaborate on any of your answers and add any further comments: Should be Empty: Submit This page uses TLS encryption to keep your data secure.