Questionnaire to be completed by groups who are members of the Volunteer Food Service Central Office

Posted mars 19th, 2009 by François Lahaise

Questionnaire to collect data concerning groups who are members of the Volunteer Food Service Central Office. For more information, please contact Clarisse Bonnefon at 514.842.3351.

Name and number of MOW / Lunch Club : *

Name of organization :

If different.

Name & type of building in which service is located : *

Eg: St Mark's Church or Presbytery, NDG Community Centre...

Address : *

Postal code : *

Phone number : *

Fax number :

E-mail :

Website :

Preferred language for correspondence : *

English

French

Business hours of organization : *

Year meal sevices began (Meals on wheels / Lunch club) : *

Number of delivery routes : *

Area(s) and/or borough(s) served : *

Territory limits (example - N: Sherbrooke, S: Notre-Dame, E: Papineau, W: St-Denis)

North : *

South : *

East : *

West : *

Closing period(s) :

Ex.: "closed from June 24th until Labour Day" or "from Dec. 23rd until Jan. 5th".

Do you offer alternative services when closed? If so, please describe :

Person in charge

(Please note that this person will receive all Volunteer Food Services Central Office & VBM mailings, unless otherwise indicated in the space for "other info/comment," below.)

Name & title : *

Name & title (example: Mrs. Patricia Smith, director).

Address :

If different from organization.

Phone number :

If different from organization.

Fax number :

If different from organization.

E-mail :

If different from organization.

Person in charge of clients of client registration

Name & title :

If different from the person in charge mentioned above.

Phone number :

If different from the person in charge mentioned above.

Fax number :

If different from the person in charge mentioned above.

Adresse e-mail :

If different from the person in charge mentioned above.

President of the organization

(if different from the person in charge)

Nom :

Phone number :

Kitchen

(if not located at above address)

Emplacement :

Eg: NDG Community Center, St Mark's Church, etc.

Kitchen phone number :

Kitchen address :

Services for Meals on Wheels groups

Days of meal-service or delivery :

Example: Monday, Wednesday, Saturday.

Current number of clients :

Maximum number of clients / meals :

Number of meals served per week :

Cost to client :

Services for lunch clubs

Days of meal-service or delivery :

Example: Monday, Wednesday, Saturday.

Current number of clients :

Maximum number of clients :

Number of meals served per week :

Cost to client :

Do you offer a transportation service for your clients? If so, cost of service :

For all groups

Meal supplier (hot) : *

* Name of supplier :

Price paid to the supplier :

Menu options

Soup : *

Salad : *

Dessert : *

Other (if so) :

Type of cuisine : *

Traditional Canadian and-or

Other

Please specify :

Do you considerate your meals low fat, low salt? : *

What alternative(s) do you offer? : *

No specialized menus are available

Special desserts for people with diabetes

Special alternatives for those with allergies, specific preferences, or particular health problems

Frozen meals (cooked by your organization or outside caterer? If so, which caterer)

Other

Please describe :

Can clients receive more than one meal per delivery? : *

Yes

Source of client referrals : *

Central office

Word-of-mouth

CLSC

Other

If you selected "CLSC" or "Other", please specify :

Does the group pay rent? : *

Yes

If so, how much? :

Landlord’s name :

Funding, sponsorships, other sources of revenue (please describe) : *

Which of the following services offered by the Central Office does the group use? : *

If you selected "Other", please specifiy :

Is your group affiliated with organizations other than the VBM? : *

Yes

If so, which one(s)? :

Volunteers

Volunteer co-ordinator (if any) :

Phone number :

Approximate number of volunteers :

If you selected "Other", please specifiy :

Section for groups which use the Central Office's liaison service

* Made out to :

Do you call new clients before each delivery? : *

Yes

Which phone number(s) do you give to your clients? : *

That of the group

The Central Office’s number

What is the best place or the best person to call to cancel a delivery the same day? :

Name and phone number.

Other information and comments

Please describe :

If you have any questions, contact Clarisse Bonnefon at 514.842.3351

Thank you very much for your valuable input!
The Meals on Wheels Central Office.

If you want a copy, print it before submit, because the information disappear after.

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Questionnaire to be completed by groups who are members of the Volunteer Food Service Central Office

Person in charge

Person in charge of clients of client registration

President of the organization

Kitchen

Services for Meals on Wheels groups

Services for lunch clubs

For all groups

Volunteers

Section for groups which use the Central Office's liaison service

Other information and comments