NAME AND SURNAME OF COUNSELLOR

First Name

Last Name

REPORT FOR MONTH

YEAR

ORGANISATION WHERE SERVICES WERE RENDERED

BRANCH/ LOCATION

1. COUNSELLING SERVICES

1.1 Utilization of counselling this month

Low, things are slow

Satisfactory

High, can’t keep up

1.2 Any new Intakes this month?

1.3 Challenges, Positives and Trends regarding counselling utilization at this organisation this month

2. GR0UP ACTIVITIES

2.1 Were you involved in any Event, Training, Talk, Life skill programme or any other Group Activity this month?

If YES Indicate nature of Group/Topic

If NO Your suggestions/challenges regarding Group activities at this organisation

3. WELLNESS AWARENESS

3.1 Did you receive any feedback from the Organisation regarding this month’s Wellness posters/Blog content?

If YES Please share feedback received

If NO Please share your challenges to obtain feedback from Clients/Staff members

3.2 Can we improve on visibility /wellness awareness at this organisation

Please share your thoughts/suggestions

4. GENERAL

Did you manage to work your allocated hours this month?

If NO Please provide reason

Other comments regarding the allocated hours

Did you experience any challenges at this organisation in terms of

Completing and submitting Activity sheets

Completing and submitting Intake forms

Obtaining Consent forms

Confirmation and attendance of appointments

Receiving Client Reference numbers

Updating the Client List

If you answered YES to any of the above or wish to bring anything else to our attention, please provide details

Please share your suggestions and planning with us*