RSVP Caregiver Hour Log

RSVP Volunteer Caregiver Hour Log

* Indicates required field

Care Receivers Name *

First

Last

Dates of Care I Service Provided I Hours I Miles of travel *

Services Provided

Transportation /Outings
Friendly Visiting
Light Housekeeping / House Repair
Meal Preparation
Respite Care
Shopping
Telephone Assistance
Office Work / Fund Raising
Other

Special Note: Please be sure to list the total amount of time you spent volunteering including from the time you left home until the time you returned. Round up to the half hour. If you want a letter from the RSVP office stating your volunteer mileage for the year, you must record the miles you have driven for each date of volunteer service. We will total all mileage at the end of the year and give you a letter for tax purposes. If you are not tracking mileage, please do not record it.

click here for a PRINTABLE HOUR LOG rsvp_vol_caregivers_hour_log_2.2016.pdf

RSVP Caregivers Name *

First

Last

Email *

Submit

RSVP Volunteer Caregivers is a project of the Western Dairyland Community Action Agency
23122 Whitehall Road - Independence, WI 54747 - 715-985-2391 ext. 1205