Melissa Downer

Outreach

Daily Logs

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Title Page

Date
Volunteers
Location
Log Entry

Demographics

Gender
First Letter of First Name
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- K
- L
- M
- N
- O
- P
- Q
- R
- S
- T
- U
- V
- W
- X
- Y
- Z
Month of Birthday
- January
- February
- March
- April
- May
- June
- July
- August
- September
- October
- November
- December
Day of Birthday
First Letter of Mom’s First Name
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- K
- L
- M
- N
- O
- P
- Q
- R
- S
- T
- U
- V
- W
- X
- Y
- Z
Race

Naloxone

Naloxone
Type
- Intramuscular
- Auto-injector
- Nasal
Amount of IM
Amount of AI
Amount Nasal
Reversals
Amount of Reversals
Amount Unable to Reverse
Longs or Shorts
- Longs
- Shorts
Amount of Longs
Amount of Shorts

Add-ons

Extra Bags
- Yes
- No
- N/A
Longs or Shorts
Amount of Extra Longs
Amount Extra Shorts
Extra Boxes
Longs or Shorts
Amount Extra Longs
Amount Extra Shorts
Oil Burners
Amount of Oil Burners

Donations

Donation
Donation Amount

Melissa Downer

Outreach

Daily Logs

Use this Template

Print as PDF

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