Community Chest Activity Information (To be completed at the end of the project) - Page 1 of 4 - London Borough of Havering Council

Impact of the Grant on your Organisation

1. Name of person completing this survey?

(Required)

2. What is your email address?

(Required)

3. What is the name of the organisation?

(Required)

4. Has the community chest grant widened your services offer. Please tell us the type of services you offer now?

(Required)

5. What are your service priorities?

Cost of Living Learning Difficulties and Disabilities Long Term Conditions Mental Health

6. Start Date of Project?

(Required)

Day (dd)
-

Month (mm)
-

Year (yyyy)

7. End Date of Project?

(Required)

Day (dd)
-

Month (mm)
-

Year (yyyy)

8. What is the make up of residents using the service now?

Please provide an overview of demographics and characteristics of the residents attending your service. This may include demographics such as (gender, race/ethnicity, religious belief, sexuality , geography, age).

(Required)

9. If you do not receive Social Prescribing referrals, how did residents engage with your service?

(Required) Self referral Voluntary Sector referrals Social Care Other, please specify

10. Number of social prescribing referrals declined?

(Required)

11. Typical waiting times for residents to access the service?

(Required)

12. Did the funding enable you to receive Social Prescribing or Local Area Coordinators referrals?

(Required)

13. What was the total number of social prescribing referrals accepted, against the total number of residents accessing your service?

For example if you accept 5 social prescribing referrals over the defined time frame against 20 residents seen overall - this should be displayed as 5/20

(Required)