Outreach Records Form – Justice Service Date Select GroupSelect GroupGroup 2Group 3Group 4Group 5Full name of Team MemberDid you bring an individual/family?– Select –IndividualFamilyHow many guests did you bring?– Select –12345PreviousNextFamily members’ names (kindly use bullets/numbers)From which of your communities did you bring this family?– Select –My home locationMy work locationOther location-State locationWas the family delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from family we need to attend to?– Select –YesNoState feedbackIs the family willing to repeat a visit?– Select –YesNoReasonIs the family willing to be a part of CCI?– Select –YesNoDid the family also come for Healing & Miracle Line?– Select –YesNoWhat was the family’s overall feedback?PreviousNextFirst GuestFirst guest’s nameFrom which of your communities did you bring your guest?– Select –My home locationMy work locationOther location-State communityWas this guest delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from this guest we need to attend to?– Select –YesNoState feedbackIs this guest willing to repeat a visit?– Select –YesNoReasonIs this guest willing to be part of CCI?– Select –YesNoDid this guest also come for Healing & Miracle Line?– Select –YesNoWhat was the guest’s overall feedback?PreviousNextSecond GuestSecond guest’s nameFrom which of your communities did you bring your guest?– Select –My home locationMy work locationOther location-State communityWas this guest delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from this guest we need to attend to?– Select –YesNoState feedbackIs this guest willing to repeat a visit?– Select –YesNoReasonIs this guest willing to be part of CCI?– Select –YesNoDid this guest also come for Healing & Miracle Line?– Select –YesNoWhat was the guest’s overall feedback?PreviousNextThird GuestThird guest’s nameFrom which of your communities did you bring your guest?– Select –My home locationMy work locationOther location-State communityWas this guest delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from this guest we need to attend to?– Select –YesNoState feedbackIs this guest willing to repeat a visit?– Select –YesNoReasonIs this guest willing to be part of CCI?– Select –YesNoDid this guest also come for Healing & Miracle Line?– Select –YesNoWhat was the guest’s overall feedback?PreviousNextFourth GuestFourth guest’s nameFrom which of your communities did you bring your guest?– Select –My home locationMy work locationOther location-State communityWas this guest delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from this guest we need to attend to?– Select –YesNoState feedbackIs this guest willing to repeat a visit?– Select –YesNoReasonIs this guest willing to be part of CCI?– Select –YesNoDid this guest also come for Healing & Miracle Line?– Select –YesNoWhat was the guest’s overall feedback?PreviousNextFifth GuestFifth guest’s nameFrom which of your communities did you bring your guest?– Select –My home locationMy work locationOther location-State communityWas this guest delighted to be in CCI?– Select –ExtremelyJust okayIndifferentNot delightedAny feedback from this guest we need to attend to?– Select –YesNoState feedbackIs this guest willing to repeat a visit?– Select –YesNoReasonIs this guest willing to be part of CCI?– Select –YesNoDid this guest also come for Healing & Miracle Line?– Select –YesNoWhat was the guest’s overall feedback?PreviousNextAny peculiar challenges to be noted?– Select –YesNoState challenges (kindly use bullets/numbers) Previous Submit Form
