Service Delivery Plan

Appendices

Appendix D - Sample Budget Checklist

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Salaries and Benefits:

• Staff 1:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Staff 2:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Staff 3:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Casual Staff for High Needs Clients:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Benefits:
  • Monthly Budget:
  • Yearly Budget:
    
    
  • Total Salaries and Benefits:
    • Monthly Budget:
    • Yearly Budget:

Supplies:

• Medical Supplies and Equipment:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Office Supplies:
  • Monthly Budget:
  • Yearly Budget:
    
    
  • Total cost of supplies:
    • Monthly Budget:
    • Yearly Budget:

Operating Expenses:

• Staff Development:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Insurance:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Professional Fees:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Telephone:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Cartage:
• Monthly Budget:
• Yearly Budget:
  
  
• Administration Costs:
• Monthly Budget:
• Yearly Budget:
  
  
• Total Operating Expenses:
  • Monthly Budget:
  • Yearly Budget:

Transportation Expenses:

• Employee travel:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Vehicle Lease:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Licence and Insurance:
  • Monthly Budget:
  • Yearly Budget:
    
    
• Fuel and Maintenance:
  • Monthly Budget:
  • Yearly Budget:
    
    
  • Total Transportation Expenses:
    • Monthly Budget:
    • Yearly Budget:

Contingency Fund for High Need Clients:

• Total Amount for High Need Clients:
  • Monthly Budget:
  • Yearly Budget:

Funding From Other Sources:

• Building Healthy Communities Home Nursing(for those communities who are eligible and received this funding):
  • Monthly Budget:
  • Yearly Budget:
    
    
• DIAND Adult Care Program (In-Home Component)(for those communities who are eligible and received this funding):
  • Monthly Budget:
  • Yearly Budget:
    
    
• Other Community Based Funding:
  • Monthly Budget:
  • Yearly Budget:
    
• Provincial/Territorial Funding:
• Monthly Budget:
• Yearly Budget:
  
  
• Total Funding Revenue:
  • Monthly Budget:
  • Yearly Budget: