FOOD PANTRY Monthly Report Form


Thank you for completing the online FOOD PANTRY REPORT SYSTEM information!

This form is your monthly access for submitting statistical data used in completing reports to determine possible outcomes and assistance. The consecutive use of this reporting system allows us to evaluate and assess the conditions related to food programming and insecurities in Hamilton County.

You have opportunity to report from any or all of these sections/categories:

    • FOOD PANTRY
    • FOOD BANK
    • COMMUNITY MEAL PROGRAM
    • BAGGED LUNCH PROGRAM

Based on your selection of one or more of these categories you will see the appropriate fields for completion. Note that many of the general fields are “required” - and you will not be able to submit the form until those fields are completed.

INSTRUCTIONS:

    • You’ll simply return to this ONLINE form as often as needed (monthly) to submit reporting/data. ( If you are entering data for the previous year -- be sure to select 2014 as the year in the date fields. For that year you can enter complete data for the entire period (1/1/2014-12/31/2014) at one time - if you have cumulative statistics ready - or month by month if you prefer. )
    • If you DO NOT KNOW an answer or how to respond, simply leave the field BLANK
    • Round out all “numerical” entries to the next highest number
    • DO NOT ENTER ANY TEXT in a “numerical” or “percentage” field – you will ONLY be able to use numbers
    • If you select "extremely limited" under Food/Supply Inventory section - a drop down will allow you to check off any needed inventory food items
    • NOTE: To navigate the site you must use the "PREVIOUS" and/or "NEXT" buttons at the bottom of each page and NOT the URL arrow buttons at the top.

This "ONLINE" form is a work in progress. We welcome your input and suggestions at any time.

Simple request... start TRACKING:

If you currently are NOT tracking specific data for any of the the requested fields in this form, by the NEXT reporting period (next MONTH), please add any of those fields to your Pantry information/collection form for future data entry work. This helps put us all on common ground for evaluation and assessment and helps you organizationally be informed!

Simply select the appropriate statements below, and let’s get started. When you have completed all sections simply hit the "submit form" button at the very end.

Select as many statement(s) that apply as needed for this report:*
Reporting month/period START date*
Click on the "calendar" icon. YOU need a START DATE and an END DATE - be sure the MONTHS and YEAR are correct for this PERIOD of reporting
Reporting month/period END date*

CONTACT Information

Directions: Please list the contact details clearly. Some fields are (*) required. 

This should be the actual "PANTRY" name - or if y ou do not have a pantry name you can list the legally responsible/sponsoring organization name
Organization's Physical Address*
Organization's Mailing Address (IF DIFFERENT than PHYSICAL Address)
Please list the best contact phone.
Organization Serves What Township?*
Select as many "Township(s)" as you serve. If you serve "All Hamilton County Townships" select that option alone.
Contact Person's Full Name*
List specific hours, days, frequency of visits/etc. Complete this once annually and edit as needed.
List specific requirements your organization may have for client assistance. Complete this once annually and edit as needed.

General

Complete this section once annually and edit as needed.

Are you a member of the GOOD SAMARITAN NETWORK - having completed a MOU?*
Is the organization represented above a 501c3 organization?*
Is the organization associated with a church?*

FOOD PANTRY

NUMBERS ONLY
NUMBERS ONLY
NUMBERS ONLY
NUMBERS ONLY
NUMBERS ONLY
NUMBERS ONLY
During this month/period did you "purchase" or "receive" food from any sources:
Select all that apply and list accumulated totals by category (purchased and/or received)
Ex: Ex: I place a $XXX cash value for my total food received or distributed
Ex: I place a $XXX worth/value for my total food purchase - the value may be greater than the "CASH VALUE"
What is the current FOOD SUPPLY/SELECTION inventory of your "food pantry" as of this month/reporting period? - Copy
Based on your response above - select the current/greatest FOOD SUPPLY inventory need(s):
NUMBERS ONLY are allowed
NUMBERS ONLY are allowed

FOOD BANK

What is the current FOOD SUPPLY/SELECTION inventory of your "food bank" as of this report?
During this month/period did you "purchase" or "receive" food from any sources:
Select all that apply and list accumulated totals by category (purchased and/or received)
Ex: I paid $XXX for my total food purchase - but it's actual worth/value is $XXXX
Ex: The total actual value and worth of food I received is $XXXX
Based on your response above - select the current/greatest FOOD SUPPLY inventory need(s):
NUMBERS ONLY are allowed
NUMBERS ONLY are allowed

COMMUNITY Meal Program

NUMBERS ONLY are allowed
NUMBERS ONLY are allowed

BAGGED LUNCH Program

Directions: Please list the employee’s goals for the upcoming year. Provide timeframes and milestones where appropriate.

Is a seasonal event associated with this month/period's report? Check all that apply:
NUMBERS ONLY are allowed
NUMBERS ONLY are allowed
Select as many ages/categories that apply who participated in ALL your "bagged lunch programs" during this month/period:

Food Insecurities Grid

This statistical information is critical to support all organizations and is invaluable to help track statistical data that can drive outcomes, programming and possible grant streams to help Hamilton County agencies and residents! Select any that apply to your Pantry:

Matrix
Matrix
  Strongly Agree Agree Neutral Disagree Strongly Disagree
In the past month we had a majority of NEW people attend:
In the past month we experienced primarily the SAME people in attendance:
In the past month do you believe household/participants use your services due to the rising cost of living or limited food?
In the past month do you believe household/participants had fewer meals in a day because there was not enough food?
In the past month do you believe household/participants went to sleep at night hungry because there was not enough food?
In the past month do you believe household/participants were not able to eat foods they preferred because of a lack of resources?
In the past month do you believe household/participants had to choose between utilities and food for their family?
In the past month do you believe household/participants had to choose between medical care and food for their family?

Authorization

 

By hitting the submit button I affirm that I am authorized to provide the statistical data as listed and that it is valid. 

I am authorized to provide statistical data*
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