HTML Preview Sample Monthly Activity page number 1.
540 Albert Street East
P.O. Box 277
Sault Ste Marie, ON
P6A 5L8
(705) 759-5266
www.ssm-dssab.ca
MONTHLY ACTIVITY REPORT
Name:
Case Manager:
Address:
Reporting Period
From the 16
th
of _______ to the 15
th
of ________ , 20___.
Phone Number:
As a participant of Ontario Works, you are required to advise your Case Manager of your efforts to
comply with your Ontario Works Participation Agreement. Please complete this form and return it
between the 16
th
and 22
nd
of the month, with your Monthly Statement of Income.
FAILURE TO RETURN THIS REPORT MAY RESULT IN NON-COMPLIANCE WITH ONTARIO WORKS.
Did you:
Yes
No
Date(s):
Name of Organization & details:
F
ind
Employment (Paid Employment)?
☐ ☐
______ _____________________________
Register with an employment agency?
☐ ☐ ______ _____________________________
Attend School?
☐ ☐
______ _____________________________
Attend training?
☐ ☐ ______ _____________________________
Attend an Employment Resource Center?
☐ ☐ ______ _____________________________
Are you considering Self
-
Employment?
☐ ☐
______ _____________________________
Other?
☐ ☐ ______ _____________________________
NEW VOLUNTEER WORK
Did you volunteer at a non-profit or public agency last month? (Assisting in your child’s school/class,
committee member, coaching/assisting sports organizations, Fire Department/First Response,
Community Carnival/Fair, Tournaments, etc.)
☐Yes ☐No
If yes, complete the following table:
Dates:
Total Hours:
Organization:
Job Title:
Description of Duties:
REVERSE SIDE MUST BE COMPLETED