CONCEPT MOCK-UP — prepared for discussion • not an official Provincial web page
Impact and reporting

Impact 2026 survey template

The reporting template for activity between 1 January and 31 December 2026.

This webpage is a readable preview of the supplied template. It does not submit or save information.

Information is sought for the period between 1st January 2026 and 31st December 2026

Please refer to the Guidance Notes when completing this template.

PART A – Lodge/Chapter information and contact details (*delete as appropriate)PART A – Lodge/Chapter information and contact details (*delete as appropriate)
Name of Lodge / Chapter* 
Number of Lodge / Chapter* 
Your Name 
Your Role within the Lodge/Chapter* 
E-mail address 
Contact phone number 

*Delete as appropriate

PART B – Financial donations made to registered charitiesPART B – Financial donations made to registered charitiesPART B – Financial donations made to registered charities
How many registered charities did your Lodge/Chapter support?How many registered charities did your Lodge/Chapter support? 
List the registered charities supported and amounts donated:List the registered charities supported and amounts donated:Amount (£)
1  
2  
3  
4  
5  
TOTALTOTAL£

Create additional rows as required

PART C – Financial donations made to good causesPART C – Financial donations made to good causesPART C – Financial donations made to good causes
How many good causes did your Lodge/Chapter support?How many good causes did your Lodge/Chapter support? 
List the good causes supported and amounts donated:List the good causes supported and amounts donated:Amount (£)
1  
2  
3  
4  
5  
TOTALTOTAL£

Create additional rows as required

PART D – Lodge and Chapter VolunteeringPART D – Lodge and Chapter VolunteeringPART D – Lodge and Chapter Volunteering
How many Lodge/Chapter volunteering events did you organise?How many Lodge/Chapter volunteering events did you organise? 
List the organisations supported and hours given:List the organisations supported and hours given:Event Hours
1  
2  
3  
4  
5  
TOTALTOTAL 

Create additional rows as required

PART E – Volunteering by individual members outside of the LodgePART E – Volunteering by individual members outside of the LodgePART E – Volunteering by individual members outside of the LodgePART E – Volunteering by individual members outside of the LodgePART E – Volunteering by individual members outside of the Lodge
How many members take part in voluntary work outside of the Lodge? (base this on the number of volunteer proformas returned to you)How many members take part in voluntary work outside of the Lodge? (base this on the number of volunteer proformas returned to you)How many members take part in voluntary work outside of the Lodge? (base this on the number of volunteer proformas returned to you)How many members take part in voluntary work outside of the Lodge? (base this on the number of volunteer proformas returned to you) 
What is this figure as a percentage of your membership? (your secretary will be able to advise on Lodge membership)What is this figure as a percentage of your membership? (your secretary will be able to advise on Lodge membership)What is this figure as a percentage of your membership? (your secretary will be able to advise on Lodge membership)What is this figure as a percentage of your membership? (your secretary will be able to advise on Lodge membership) 
List the organisations supported: (even if an organisation is mentioned several times, only list it once)List the organisations supported: (even if an organisation is mentioned several times, only list it once)Registered CharityRegistered CharityTOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
List the organisations supported: (even if an organisation is mentioned several times, only list it once)List the organisations supported: (even if an organisation is mentioned several times, only list it once)YESNOTOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
1   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
2   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
3   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
4   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
5   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
6   TOTAL ANNUAL HOURS OF TIME SPENT VOLUNTEERING IN THE COMMUNITY BY YOUR LODGE MEMBERS
TOTALTOTAL   

There is a worked example attached to the Guidance Notes. Add more rows as required.

Circulate the Volunteering Proforma to your members to complete this part of the Template

Only Lodges need to complete this Section of the Template

Please add any photos that you would like to share in relation to any section of this template in the space below, and a short caption explaining what is happening

Please submit this completed template to the Provincial Grand Charity Steward by:

8th January 2027 by e-mail or post.

E-mail: provchstwd@yorkshirenerfreemasons.org.uk

Post: Des McKenzie PGCS, Postal address available from the Provincial Charity Team

Photos

[add here]