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PBC Covid Neighbourhood Aid (Report Form)
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Your name
(eg. Lee Family / Acronym / Anonymous)
Your answer
Date
Date you delivered aid
MM
/
DD
/
YYYY
Recipient's Housing Estate / General Area
e.g. Sec 7, PJ / Taman OUG / Puchong Jaya / ...
Your answer
No. of Families helped
1
2
3
Other:
Clear selection
Follow-up action/s
(At your discretion / From your phone call with recipient)
I plan to / I have called recipient the following day
I plan to keep in touch with recipient weekly / every 2 weeks
Recipient has medical needs that we can follow up on
Recipient requires e-learning facilities for child/ren.
Other:
Photos?
Submit your photos or stories (if any) to our Facebook page at
https://www.facebook.com/PBC-Food-Aid-Initiative-105016138533565/
Yes
No
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