Volunteer Hours and Activity Log – Nursing Home

Sign-in log capturing volunteer hours by program area, activity type, and resident interaction for grant reporting, regulatory compliance, and volunteer recognition at long-term care and skilled nursing facilities.

Volunteer Identification

• Volunteer Full Name
• Volunteer ID / Badge Number
  If you have been assigned a facility volunteer ID or badge number, enter it here.
• Email Address
  Optional — used to send confirmation of logged hours.
• Phone Number
• Affiliated Organization or Program
  Enter the name of the organization, school, or program you are volunteering through, if applicable.
• Volunteer Type

Visit Date and Hours

• Date of Visit
  Select the date on which this volunteer service took place.
• Time In (Arrival)
• Time Out (Departure)
• Total Hours Volunteered
  Enter total hours as a decimal (e.g., 1.5 for 1 hour 30 minutes). Must match your Time In and Time Out entries.
• Round-Trip Mileage (if claiming reimbursement)
  Optional — complete only if your program reimburses or tracks volunteer travel mileage for grant reporting.

Program Area and Activity

• Primary Program Area
  Select the program area that best describes your primary activity today.
• If 'Other', please describe the program area
• Activity Description
  Be specific — include activity type, location within the facility, and any notable outcomes. This narrative supports grant reporting.
• Grant or Funding Program (if known)
  If your volunteer service is associated with a specific grant or funding program, select it here. Contact the volunteer coordinator if unsure.

Residents Served

• Number of Residents Directly Served
  Count of individual residents you interacted with during this visit. Enter 0 if your work was entirely administrative.
• Care Unit(s) Visited
  Select all units where you provided services today.
• Service Format

Incident and Safety Reporting

• Did any incident, accident, or safety concern occur during your visit?
• Describe the incident or safety concern
  Do NOT include resident names or other HIPAA-protected information. Report to the charge nurse or supervisor immediately if you have not already done so.
• Was a staff member notified of the incident before your departure?

Volunteer Attestation

• I confirm that the hours and activities recorded above are accurate, and I understand that this information may be used for grant reporting and volunteer recognition.
• Volunteer Signature
  Sign to certify the accuracy of this volunteer hour log entry.
• Additional Notes or Feedback (Optional)