Standard Mobile Pantry Report Form
ONLY SUBMIT IF YOU ARE PARTICIPATING IN THE MOBILE PANTRY TRUCK OR PRODUCE DROP/EXPRESS PROGRAM WITH NTFB.
Agency Name & Number
*
Please type Agency's name as listed on program/product invoices.
Date
-
Month
-
Day
Year
*Please type or choose the distribution date.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Week of the month
Week 1
Week 2
Week 3
Week 4
Week 5
Year
2015
2016
2017
2018
2019
2020
Total number of households served
*
Please enter the number of unduplicated households served during report month
Total number of clients served
Please enter the number of total CLIENTS served based on household data gathered
Name
*
First Name
Last Name
Title
*
Examples: Program Contact, Dept Manager/Director,
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
# of Volunteers
Including yourself, how many people volunteered their time to help with distribution?
Did you experience any of the following issues during food distribution?
1- Volunteer shortage
2- Complaint
3- Produce quality (>20% unusable of particular item)
4- Weather delay
5- Delivery tardiness
6- Equipment damage/misuse
7- Altercation during MP service
8- Leftovers (>10% product invoiced)
Other
Please describe issue(s) as checked above, as well as any resolutions or troubleshooting activities as/if applicable. *Note: Any complaints/grievances between clients, agencies/sites, and/or NTFB staff will require a separate, formal report.
# of hours worked by volunteers
If volunteers worked for different amounts of time, please add ALL volunteer hours together for this total.
Submit
Should be Empty: