Grief Support Volunteer Care ReportPlease enable JavaScript in your browser to complete this form.Client Name *Volunteer Name *Name of DeceasedDate of DeathRelationship to DeceasedMonths Since Death------------------------------------------------------------------------------------------------------------1. Type of ContactPersonal VisitPhone Calls with ClientPhone calls or contact with FamilyPhone calls or contact with FVHH staffPhone calls or contact with otherCards/GiftsOther1. Date of Visit *1. Hours/Minutes *Include travel & documentation time------------------------------------------------------------------------------------------------------------How is the client doing grief work with you?CryingTalking about illness and/or deathTalking about deceasedTalking about relationship with deceased Talking about way death is currently affecting themNo grief work being done Comments on Progress/Stage of grief *Please provide a description of your impression on how the client is progressing in their grief process.How is the client grieving outside of your meetings?ReadingJournalingTalking with family/friends Attending support group(s)Seeking counseling or spiritual supportPlanning / preparing ritual to honor deceased’s memoryNo independent grief work being done What skills did you engage in during the contact?Facilitated client’s telling of storyListened Encouraged the expression of grief Validated normalcy of thoughts, feelings & behaviors of grief Affirmed good work in expressing griefHelped to identify need for supportive services OtherGrief Support Visit Summary *Please provide a brief summary of your visit.Additional challenges affecting the grief experience:FinancialFamilyHealthAvailability of support Change in work situationPrevious/recent loss experiencesConcurrent life crisisChange of address or phoneCheck where appropriate and explain below in Comments field.Comments on Additional ChallengesWhat symptoms of grief is the client reporting to be experiencing?Weight (loss or gain)Sleeping patterns disturbedLack of energy/apathyNumbnessHealth changesDifficulty concentrating/forgetfulSensing presence of deceased (ex: searching for/dreaming of)Perpetually busyAnger / bitternessFeelings of hopelessnessSuicidal thoughts (requires immediate staff contact)Apathy / lack of initiativeJealousy / envyIrritability / ImpatienceGuilt / RegretSense of reliefFrustrationAnxiety / nervousness / fearLonging / piningSadness / uncontrollable cryingDifficulty making decisionsFeelings of AbandonmentDependent on othersAvoiding others / withdrawalLack of acceptance of current realityFeeling abandoned by GodFinding comfort in religious beliefsCheck where appropriate and explain below in Comments field.Comments on Experienced Grief SymptomsHow does the client report progress with their grief? *What goals or improvements has the client worked on since your last visit? *Volunteer Plans Include:Schedule another contact with bereavedPrepare grief client for closure (3 months prior)Continue attempts to schedule a meetingClose case with this documentationCheck where appropriateSpecial concerns requiring follow-up attention:Examples: No phone contact with client for _______ month(s) or No visit with client for _______month(s) Other Comments:------------------------------------------------------------------------------------------------------------Date *Email *Volunteer Electronic Signature *WebsiteSubmit