Chase Benefice - Record of telephone call
Thank you for keeping in touch with others from the Benefice during this time of lockdown. It is hugely appreciated and important as we try to keep in touch, especially with those who are lonely at this time.

It is important that we keep a record of the conversation that you have made. Please complete this simple form each time that you make a call. It will be stored securely and only seen by the Clergy and those co-ordinating the 'Telephone Friends'.

If you have any concerns for the person that you have called, don't hesitate to contact Julie Benson (01608 676672), Sarah Tribe (07427 660338), Ilona (‭07305 355809‬) or Mark (01608 676572).

Thank you.
Your name *
Your answer
Name of the person contacted *
Your answer
Date when call made *
MM
/
DD
/
YYYY
Was everything okay with them? *
If no to the above, do they need assistance? Please tick what assistance they require from the following
If 'other' please give a brief description here. Did you suggest that they contact someone? If so, who e.g. Good Neighbours etc? Or did you feel able to offer help yourself and if so, how?
Your answer
Do you have concerns for them? Physical, emotional, spiritual? *
If yes to the above, please write your concerns here. These should be non-confidential and non-specific unless there are exceptional circumstances.
Your answer
Have you contacted anyone about your concerns?
If follow-up action is needed, please make a note of it here
Your answer
Did the person wish to have another call? *
If so, when has this been arranged for? Please include the date agreed or when you hope to call them again
MM
/
DD
/
YYYY
Finally, are you happy to continue to do this, or would you like us to find someone else? *
Thank you for your help. By clicking 'Submit' below, you are consenting to your this record to be stored on our database in accordance with our Data Protection Policy.
Thank you!
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