D.NNADAP Activity Reporting Template

D.NNADAP Activity Reporting Template

NNADAP ACTIVITY REPORTING & TRACKING REPORT

Worker:
Community:
Fiscal Year:
Reporting Period: / Month of

Each reporting period requirement varies depending the requirements of your community and FNIHB – please check to confirm what your requirements are.

Please record activities that have occurred in your community under the headings listed below.

Client Contact: Record the number of contacts you receive from the following sources

Type / Children / Youth / Adult / Elders
Phone calls
Office Visits
Home Visits
Collateral Contacts
(other agencies)
Brief Service

On the Land Based Programs completed: If a speaker comes in, to do a presentation or you do a presentation, complete a case note & record

Topic of Presentation / Where / When / # of Participants
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders

NNADAP Activity Reporting Templatepage 2

Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders

Traditional Healing Programs completed: If a speaker comes in, to do a presentation or you do a presentation, complete a case note & record.

Topic of Presentation / Where / When / # of Participants
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders

NNADAP Activity Reporting Templatepage 3

Counselling/Treatment support provided:

Type / Children / Youth / Adults / Elders

Assessment

Individual
Traditional
Couple
Family
Long Term support
Agency Collaboration
Walk In
Internal Referral
Discharge/ Planning

Support/ Intervention Groups completed: If a presenter comes in to facilitate a group, complete a case note & record.

Type / Children / Youth / Adults / Elders
Advocacy
Aftercare Support
Red Path
Grief Recovery
AA/NA/Alanon

NNADAP Activity Reporting Templatepage 4

Crisis Intervention provided: If you facilitated a group during a crisis, complete a case note & record.

Type / Crisis / When / # of Participants
Individual / Children
Youth
Adults
Elders
Family / Children
Youth
Adults
Elders
Community / Children
Youth
Adults
Elders

Information Awareness-Workshops completed: If a speaker comes in, to do a presentation or you do a presentation, complete a case note & record

Topic of Presentation / Where / When / # of Participants
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders

NNADAP Activity Reporting Templatepage 5

Training: Record if you receive a training course.

Training / Location / Certificate/ Diploma/ Hours

Awareness Campaigns provided: Record if you provided Awareness Campaigns.

Campaign/Initiatives / Location / Length / # of Participants
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders
Children
Youth
Adults
Elders

NNADAP Activity Reporting Templatepage 6

Produced Materials provided: Record if you produced materials for awareness, intervention or healing from substances.

Produced Materials / Type / Description / Group(s) targeted
Pamphlets: / Children
Youth
Adults
Elders
Posters: / Children
Youth
Adults
Elders
Brochures: / Children
Youth
Adults
Elders
Videos: / Children
Youth
Adults
Elders
Radio Stations: / Children
Youth
Adults
Elders
Newsletters: / Children
Youth
Adults
Elders