Illinois Guardianship and Advocacy Commission  
GAC Home

Pat Quinn, Governor

Navigation

Divisions:
   Office of State Guardian
   Legal Advocacy Service
   Human Rights Authority
Volunteer Guardianship Program
Meeting Notices and Agendas
IMPORTANT Advance Directives
Employment Opportunities
Online Intake Form
Annual Reports
Policy and Rules
Other State Resources
Illinois Home

[Search Tips]
Inspector General

Agencies

Illinois Legislature
This Page is...

Inspector General

Inspector General

Volunteer

diagonal image

Volunteer Visitor Form

Name of Volunteer:
Volunteer Email Address:
First and Last Name of Ward:
Facility: Date of Visit:
Location of Visit:
Length of Visit:
(in minutes, including time spent with staff and reviewing records)

Appearance of Ward: (Check All That Apply)
Neat Ambulates without assistance
Unkempt Ambulates with cane
Clean Ambulates with walker
Dirty/Stained Clothes Ambulates with wheelchair
Dressed Inappropriately
Dressed Appropriately

Mood of Ward: (Check All That Apply)
Appropriate Thought Content Inappropriate
Angry/Hostile Short Attention Span
Troubled, Sad, or Depressed Unable To Determine
Non-verbal Interaction Active
Converses Interaction Passive

Describe Visit: Yes No
Did the ward acknowledge your presence?
Was the ward doing any activities?
Was the ward satisfied with the care?
Was the ward satisfied with the staff?
Was the staff available to answer questions?


CAPTCHA Image

Please enter the above text in the box below and click submit


[ Different Image ]

State Features

Living in Illinois

GAC Features

Commissioners
Commissioners
Executive Staff
Guardianship FAQ
Regional Offices
Statutory Acts
Legal Forms
Important Legal User Information - Please Read!

 


Copyright © 2002-2011 IGAC Illinois Privacy Info | GAC Privacy Info | Kids Privacy Info | Web Accessibility | Webmaster