MRC Quarterly Reports
Your Name
Your Email Address
What MRC unit do you represent?
/ Agawam/ Amherst
/ Berkshire
/ Boston
/ Bridgewater
/ Bristol-Norfolk
/ Brockton
/ Brookline
/ Burlington
/ Cape Cod
... 25 additional choices hidden ...
/ Topsfield Regional
/ Town of Grafton
/ Town of Longmeadow
/ Town of Monson
/ University of Massachusetts
/ Upper Merrimack Valley
/ Wachusett
/ West Springfield
/ Wilbraham
/ Worcester
What is your unit's region?
/ Region 1/ Region 2
/ Region 3
/ Region 4A
/ Region 4B
/ Region 4C
/ Region 5
Has there been a change in the sponsoring organization since the last quarterly update? (If there has, we will ask you to describe this in more detail later in the report.)
/ Yes/ No
Has there been a change in the community/jurisdiction served since the last quarterly update? (If there has, we will ask you to describe this in more detail later in the report.)
/ Yes/ No
Has been there been a change in the mailing address/contact information since the last quarterly update? (If there has, please describe it in more detail later in the report.)
/ Yes/ No
How many volunteers are currently in your unit?
Is your unit currently a member of MA Responds?
/ Yes/ No
Does your unit perform CORI checks?
/ Yes/ No
How often do you perform them?
Have all of your volunteers been CORI checked?
/ Yes/ No
How many need to be checked?
Does your unit perform SORI checks?
/ Yes/ No
How often does your unit perform SORI checks?
Have all your volunteers been SORI checked?
/ Yes/ No
How many need to be checked?
What professional license checks do you perform on your volunteers? (Please check all that apply.)
/ Physician - MA Board of Registration in Medicine/ Counselor, Substance Abuse and Behavioral Disorder - MA Bureau of Substance Abuse Services
/ Clinical Nurse Specialist, Psychiatric-Mental Health - MA Division of Health Professions Licensure
/ Counselor, Genetic - MA Division of Health Professions Licensure
/ Dental Hygienist - MA Division of Health Professions Licensure
/ Dentist - MA Division of Health Professions Licensure
/ Licensed Practical Nurse - MA Division of Health Professions Licensure
/ Nurse Anesthetist - MA Division of Health Professions Licensure
/ Nurse Midwife - MA Division of Health Professions Licensure
/ Nurse Practitioner - MA Division of Health Professions Licensure
/ Perfusionist - MA Division of Health Professions Licensure
/ Pharmacist - MA Division of Health Professions Licensure
/ Pharmacist, Nuclear - MA Division of Health Professions Licensure
/ Pharmacy Technician - MA Division of Health Professions Licensure
/ Physician Assistant - MA Division of Health Professions Licensure
/ Registered Nurse - MA Division of Health Professions Licensure
/ Respiratory Therapist - MA Division of Health Professions Licensure
/ Athletic Trainer - MA Division of Professional Licensure
/ Aud/Speech Pathologist, Clinical - MA Division of Professional Licensure
/ Audiologist - MA Division of Professional Licensure
/ Audiologist Assistant - MA Division of Professional Licensure
/ Chiropractor - MA Division of Professional Licensure
/ Counselor, Mental Health - MA Division of Professional Licensure
/ Counselor, Rehabilitation - MA Division of Professional Licensure
/ Dietitian - MA Division of Professional Licensure
/ Embalmer - MA Division of Professional Licensure
/ Funeral Director - MA Division of Professional Licensure
/ Health Officer - MA Division of Professional Licensure
/ Licensed Independent Clinical Social Worker - MA Division of Professional Licensure
/ Marriage & Family Therapist - MA Division of Professional Licensure
/ Massage Therapist - MA Division of Professional Licensure
/ Nutritionist - MA Division of Professional Licensure
/ Occupational Therapist - MA Division of Professional Licensure
/ Optometrist - MA Division of Professional Licensure
/ Physical Therapist - MA Division of Professional Licensure
/ Physical Therapy Assistant - MA Division of Professional Licensure
/ Podiatrist - MA Division of Professional Licensure
/ Psychologist - MA Division of Professional Licensure
/ Psychologist, Licensed Educational - MA Division of Professional Licensure
/ Registered Dispensing Optician - MA Division of Professional Licensure
/ Licensed Certified Social Worker - MA Division of Professional Licensure
/ Licensed Social Worker - MA Division of Professional Licensure
/ Licensed Social Worker Associate - MA Division of Professional Licensure
/ Speech Language Pathologist Assistant - MA Division of Professional Licensure
/ Veterinarian - MA Division of Professional Licensure
/ EMT – Basic - MA Office of Emergency Medical Services
/ EMT – Intermediate - MA Office of Emergency Medical Services
/ EMT - Paramedic - MA Office of Emergency Medical Services
How often do you check a volunteer's professional license?
How many orientation or recruitment meetings have you held this quarter?
What were the dates of these orientation/recruitment meetings?
How many attendees attended the volunteer/recruitment meetings (total for the quarter)?
How many trainings/drills did your unit complete last quarter? Please do NOT include EDS trainings/drills.
What were the dates of these non-EDS trainings/drills?
How many volunteers (in total) attended these non-EDS trainings/drills?
How many EDS trainings/drills were completed since the last quarter?
What were the dates of the EDS trainings/drills?
How many participants attended (in total) the EDS trainings/drills for the quarter?
How many coalition meetings did a representative from your unit attend this quarter?
Please describe any collaborations you have had with other MRC units or other organizations since the last quarter.
What issues would you like to bring up at this time? (Issues can include a change in sponsoring organization, unit leadership or communities served.)
Since last quarter, have you applied for any grants?
Since last quarter, have you been awarded any grants?
If there are other updates you would like to share at this time, feel free to do so.