We help seniors resolve legal & long-term care problems

Ombudsman Volunteer Report

Step 1: Fill in the boxes below after each visit to a facility.

Volunteer Ombudsman's Name (required)

Volunteer Ombudsman's Email (required)

Name of Facility (required)

Date Of Facility Visit (required) MM/DD/YY

Number of minutes to travel to facility (required)

Time you arrived at the facility for your visit (required)

Time you left the facility after your visit (required)

Number of residents you had contact with (required)

If you attended a Resident Council meeting:

The total minutes spent with Resident Council

The number of residents attending the meeting

I called the following staff Ombudsman about today's activity: (required)

I need the following materials: (required)
NoneTransfer / Discharge Rights Fact SheetsResident Rights PamphletsCrime Victim Rights / Assistance MaterialsCommunication Pages for Residents Unable to SpeakTable Tents

Delivery of materials: (required)
NoneMail the materials to meI will arrange to pick the materials up at Pro Seniors

Our LTC Ombudsman Role is to recognize concerns and to advocate for the rights of residents. As the advocate for residents in this home, what did you notice during your visit? (required)

What did residents tell you? (required)

What did the Ombudsman staff ask you to do during your visit? (required)

How did you work on these issues today? (required)

Number of minutes to complete this report (required)

Step 2: Click on the button below to submit your Ombudsman Volunteer Report
to Pro Seniors.

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