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Funeral Planner V1.4 2021

Funeral Planner V1.44 2021

Arrangement File

Step 1- Prior To Arrangements - First Call Information

Date of First Call:

Time of First Call:

First Call Received By:

Location Call #:

File Contract #:

Membership or Association:

Information on who has passed away that we are caring for.

Notify Arranger & Arrangements of Any Name Change After Arrangements.

Confirm using phonetic letters-Is that ‘P’ as in ‘Papa’ or ‘T’ as in ‘Tango’ ?

Gender:

Title:

Name as will be on FDSD

Deceased First Name:

Deceased Middle Name:

Deceased Last Name:

Date of Birth:

Age:

Date of Death:

Time Of Death:

Notify Arranger & Arrangements of Any Date Change After Arrangements.

Below Is the Information of where they passed away

Place of Passing:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Transfer Into Our Care From:

Transfer Into Our Care (Place of Death)

Transfer Into Our Care (Calgary Medical Examiner)

Transfer Into Our Care (Edmonton Medical Examiner)

Transfer Into Our Care (other)

Doctor's Name First Name:

Doctor's Name Last Name:

Email:

Phone:

Doctor Additional Notes:

Family Present?:

Yes

Person Calling First Name:

Person Calling Last Name:

Relationship:

Email:

Phone:

Cell Phone

Same as Person Calling

Primary Contact First Name:

Primary Contact Last Name:

Relationship:

Email:

Phone:

Cell Phone

Permission to Transfer Into Our Care:

Yes

Appointment Confirmed?:

Yes

Family To Confirm

Appointment Date:

Appointment Time:

Appointment Location:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Prearrangements:

Yes

Announcement Later Calgary Herald:

Yes

Announcement Later Calgary Sun:

Yes

Discussed with Caller:

Clothing

Photo

AHC, SIN, & DL#

Obituary Information

Our Address

Family Parking

First Call Notes:

Vital Statistics Email Sent?:

Yes

Sent By:

Step 2 - Arranger Information & Vital Stats

Location:

Pre-Arrangements (Funeral Director):

Date of Prearrangements:

Funeral Director Arrangements:

Other Director:

Date of Arrangements:

Do not use CARE OF or another family member’s address

If Deceased Went By Another Name Add After First Name

In (Brackets) if name is not the middle name

or

In "Quotations" if name is one of their middle names

Deceased First Name:

Deceased Middle Name:

Deceased Last Name:

Address 1:

City

Country

State/Province

Zip/Postal code

AB Health Number:

AB Driver's License Number:

Social Insurance Number:

Government Identification:

Brought In At Time of Arrangements

Family To Provide (include date)

No Identification to be Provided

Other

Place of Birth (City/Town (If rural, give nearest city/town/village)):

Place of Birth (Province):

Place of Birth (Country):

Last Name at Birth:

Occupation:

Type of Business:

Mother's Information - use given names for first name

Mother First Name:

Mother Last Name:

Mother Maiden Name:

Mother's Place of Birth (City/Town/Village):

Mother's Place of Birth (Province):

Mothers Place of Birth (Country):

Father's Information - use given names for first name

Father First Name:

Father Last Name:

Father's Place of Birth (City/Town/Village):

Father's Place of Birth (Province):

Father's Place of Birth (Country):

STEP 3 - Executor & Contacts

Will

Yes

Same as Primary Contact

Executor / Executrix First Name:

Executor / Executrix Last Name:

Relationship:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Executor / Executrix Notes:

Legal Marital Status

Married

Divorced

Widowed

Never Been Married

Unknown

Use ``Same as Deceased`` to populate the address feilds and then edit the name.

Same as Primary Contact Same as Executor / Executrix

Spouse First Name:

Spouse Middle Name:

Spouse Last Name:

Spouse Maiden Name:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Spouse Notes:

Use ``Same as Deceased`` to populate the address feilds and then edit the name.

Divorced First Name:

Divorced Last Name:

Widowed First Name:

Widowed Last Name:

Living Arrangements:

Common Law

Living Status - Common Law

Living Status - Not Common Law

Use ``Same as Deceased`` to populate the address feilds and then edit the name.

Same as Primary Contact Same as Executor / Executrix

Common Law First Name:

Common Law Middle Name:

Common Law Last Name:

Common Law Maiden Name:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Common Law Notes:

Funeral Home Family Contact

Expand Section

Close Family Contact Section

Same as Person Calling Same as Common Law Same as Primary Contact Same as Spouse Same as Executor / Executrix

Contact 1 First Name:

Contact 1 Last Name:

Relationship:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Co-Executor 1:

Contact 1 Notes:

Contact 2

Yes

Same as Common Law Same as Primary Contact Same as Spouse Same as Executor / Executrix

Contact 2 First Name:

Contact 2 Last Name:

Relationship:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Co-Executor 2:

Contact 2 Notes:

Contact 3

Yes

Same as Primary Contact Same as Spouse Same as Executor / Executrix

Contact 3 First Name:

Contact 3 Last Name:

Relationship:

Email:

Address 1:

City

Country

State/Province

Zip/Postal code

Phone:

Work Phone

Cell Phone

Co-Executor 3:

Contact 3 Notes:

STEP 4 - Family Care / Invoice To.

Family Care:

Family Care Government Documentation

No Family Care

Confirm that the phone number is the preferred number for family care to use.

Same as Contact 3 Same as Common Law Same as Primary Contact Same as Spouse Same as Contact 2 Same as Executor / Executrix Same as Contact 1

Contact Name for Family Care First Name:

Contact Name for Family Care Last Name:

Email:

Phone:

Cell Phone

(office use only)

Family Care Ordered:

Yes

Family Care Ordered By:

Appointment Date:

Family Care Ordered On:

Family Care Notes:

Primary Invoice To

Same as Contact 3 Same as Primary Contact Same as Spouse Same as Contact 2 Same as Executor / Executrix Same as Contact 1

Primary Invoice To First Name:

Primary Invoice To Last Name:

Email:

Finalized Invoice will be:

Emailed

Other

Payment Due Date:

Payment Method:

Invoice Notes:

Is a Second Invoice Required?

Is a Second Invoice Required?:

Yes

Please select from drop down if second invoice is to someone other than listed above

Second Invoice To:

Second Invoice First Name:

Second Invoice Last Name:

Email:

Finalized Invoice will be:

Payment Due Date:

Payment Method:

Invoice Notes:

Funeral Director Statement Of Death

This document is used in Alberta for all aspects of the estate (including notifying banks, Canada Pension, Revenue Canada and land titles)

Select quantity requested

Number of Funeral Director Statement of Death :

Official Government of Alberta Death Certificate:

Death Certificate (Official)

Official Government of Alberta Death Certificate NOTES:

Step 5 - Application For Assistance

Application for Assistance:

Yes - Application for Assistance

No Application for Assistance

Same as Primary Contact Same as Spouse Same as Contact 2 Same as Executor / Executrix Same as Contact 1

Responsible Survivor First Name:

Responsible Survivor Last Name:

Relationship:

Email:

Address 1:

Address 2:

City

Country

State/Province

Zip/Postal code

Phone:

Date of Birth:

Application Submitted by:

Date Submitted:

Submission Notes:

Follow Up Arrangements:

Application Response:

Amount:

Response Notes:

Step 6 - Obituary & Brief Death Notifications

Obituary Information (online and newspaper)

Brief Death Notification:

Brief Death Notice (Online)

No Brief Death Notice (Online)

Brief Death Notice (Newspaper)

No Brief Death Notice (Newspaper)

Family To Advise Re Brief Death Notice (Online)

Family To Advise Re Brief Death Notice (Newspaper)

Other

Brief Death Notification Approved by Family?:

Yes Approved (Online) Posted Without Delay

No Not Approved (Online)

Yes Approved (Newspaper) Posted as per Below

No Not Approved (Newspaper)

Photo for Brief Death Notice:

Yes Photo Online

No Photo Online

Yes Photo Newspaper

No Photo Newspaper

Other

Photo for Brief Death Notice (Notes):

List Newspaper Name followed by date to run obituary in the "PRODUCT LABEL" field

Announcement Later

Funeral Home Website Hosting Obituary & Condolences

Yes - Online Obituary

No Online Obituary

Preparation, delivery and submission of online obituaries :

Preparation, Delivery And Submission Of Obituaries (Includes Placement On Funeral Home Website)

Photo for website?:

Black & White

Colour

2 Photo's

No Photo (funeral home website)

Other

Approved by Family?:

Yes

Obituary Uploaded to Website On:

Photo Uploaded to Website By (staff name):

Obituary Notes/Special Requests:

Newspaper Obituary

Yes Newspaper Obituary

No Newspaper Obituary

Preparation, delivery and submission of newspaper obituaries :

Preparation, Delivery And Submission Of Obituaries In Newspapers (Includes Placement On Funeral Home Website)

List Newspaper Name followed by date to run obituary in the "PRODUCT LABEL" field

"Price" field must be $1 or greater to display on contract

Obituary Costs

Obituary Cost Type :

Actual Cost

Estimated Cost

Obituary Photo:

Colour Photo

Black & White Photo

2 Photo Single Column

Double Column One Photo

Double Column Two Photo

No Photo

Family To Provide By:

Picture Received:

YES - Photo Received

No - Photo Not Received

Received by (staff name):

Logo Name:

Knights of Columbus

Daughters of the Nile

Masons

Shriners

Menorah

Other

No Logo

Description of Obituary Photo and Special Requests:

Received on:

Approved by Family (obituary text)?:

Yes

Finalized Obituary Required by (Date):

Finalized Obituary Required by (Time):

12:00pm

Other Time

For Office Use - Submitted (online & print)

Obituary Submitted?

Yes

Submitted by (name) :

Confirmed Submission By:

Notes:

Step 7 - Transferring In / Out

Are You Transferring Remains In or Out?:

Not Transferring In or Out

Transferring Out (Casket)

Transferring Out (Urn)

Transferring In (Casket)

Transferring In (Urn)

Other

Transfer In / Out Notes / Details:

Name / Location of Funeral Home Assisting:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Email:

Contact Name:

Date Contacted by Funeral Director:

Funeral Home Contacted By (funeral director name):

International Transfer: Consulate Contacted / Notes:

Transfer Notes:

Transfer In Payment Method:

Weight of deceased (lbs):

Weight of Casket / Shipping Container (lbs):

Tracking Information:

Carrier:

Flight Costs

Flight Cost Type:

Actual Cost

Estimated Cost

Weigh Bill:

Departure Date:

Departure Time:

Flight #:

Arrival Date:

Arrival Time:

Please Select All That Apply:

Document Translation Fees at Cost

Transfer In Airport Handling Fee

Known Consignor Fee for ship outs within Canada/US

Forwarding an Urn outside North America fee (plus air fee)

Known Consignor International Documentation (for overseas shipment) of Casket

Forwarding an Urn rush service fee (plus air fee)

Forwarding an Urn to USA

Forwarding an Urn outside Alberta (within Canada)

Forwarding an Urn within Alberta

Forwarding Urn Costs:

Document Translation Fees at Cost

Forwarding an Urn outside North America fee (plus air fee)

Forwarding an Urn rush service fee (plus air fee)

Forwarding an Urn to USA

Forwarding an Urn outside Alberta (within Canada)

Forwarding an Urn within Alberta

Shipping Container:

Air Tray (32" Wide, 24" Deep, 86" Long)

All-In-One Shipper (including air tray base) (25" Wide, 15" Deep, 78" Long)

Metal Liner (with glass)

Metal Liner (without glass)

Wooden Box, Metal Lined with Handles

Wooden Box for overseas shipment, painted (with handles) (32" Wide, 26" Deep, 88" Long)

Wooden Box (with handles)

Wooden Box (without handles)

Systems 5 Hermetically Sealed Liner

Banding / Sealing Required?:

Banding and Sealing (For International Only)

Transfer In / Out Fees

Step 8 - Preparations

Preparation of Deceased:

Embalming and sanitation of deceased.

Systems 5 Hermetically Sealed Liner

Preparation for Identification

Embalming, sanitation, and preparation of deceased for Private Farewell

Not Involved

Other Preparation

<<< Dressing, Cosmetology, Casketing) - Required with Embalming >>>

Preparation of Deceased:

Preparation (dressing, cosmetology, casketing).

Preparation (dressing, casketing) - without embalming

Other Preparation (2)

Cooling Facilities:

Cooling Facilities after 48 hours once transferred into our care (Unembalmed) Per Day

Cooling Facilities / Safekeeping of Deceased (Embalmed) after 30 days in our care Per Week

Shoulder Width:

Under 24"

Over 24"

Other

Weight (lbs) at time of death:

Photo Provided To Assist When Styling Hair (embalming only):

Yes

Hairstyling Notes (Included with Embalming)::

Hair Colouring (embalming only):

Hair Colouring

No Hair Colouring Requested

Nails with Acrylic Manicure (solid polish on natural nails - included):

Nails with Acrylic Manicure

No Acrylic Manicure Requested

Remove Facial Hair? :

Cosmetic Instructions (Included with Embalming)::

Preparation Notes:

Transfer Personnel:

Transfer of deceased requires 2 Transfer Personnel

Transfer with One Transfer Personnel

Other

Communicable Disease (transfer):

Remove Pacemaker?:

Yes Remove Pacemaker

No Pacemaker Present

Type of Radiation?:

Yes - Recent Radiation Treatment

No Recent Radiation Treatment

Last Treatment:

Glasses?:

Yes - Glasses

No Glasses

Glasses:

Return to Family

Donate

Leave On

In respect for the deceased our staff will bath and dress the deceased in their own clothing.

Clothing (to dress deceased in) Provided at::

At Time of Arrangements

At a Later Date

To Be Shrouded

Clothing Provided To Transfer Personnel

Funeral Home To Provide

Clothing Provide By Date:

Clothing Provide By Time:

Clothing (from place of death):

Return to Family

Discard

Return to Hospice

Use for Viewing / Identification

Placed in Casket

Personal Effects (from place of death):

Return to Family

None Expected (return to family if any personal items)

Discard All Personal Effects

Leave On / With Deceased

Other

Dentures:

Leave On

Not Applicable

Other

Hearing Aid(s):

Donate

No Hearing Aids

Not Applicable

Other

Jewelry?:

Yes Jewelry

No Jewelry

List of Items Received:

Jewelry:

Return to Family

Donate

Leave On

Items to Return (list all):

Jewelry Notes / Family Requests / Still to Come:

<<< Thumbprint Impression Taken >>>

Memorial Thumb Print:

Family Requests Memorial Thumbprint

No Memorial Thumbprint

Family To Advise Regarding Memorial Thumbprint

<<< DNA Preservation >>>

DNA Preservation and Ancestry:

DNA Banking & Ancestry Kit (at-need & pre-need)

No DNA Preservation and Ancestry

Family To Advise Regarding DNA Preservation and Ancestry

Additional Capsule & Ancestry Report from original DNA banking kit

Additional Capsule from original DNA banking kit (additional ancestry report not included)

Below Is the Information about who will be contacted when the DNA capsule is received from Securigene in 4-6 weeks.

Same as Contact 3 Same as Primary Contact Same as Contact 2 Same as Contact 1

DNA Contact First Name:

DNA Contact Last Name:

Cell Phone

Step 9 - Visitation / Identification

Visitation or Identification

Visitation (incl. Washing/Bathing/Dressing)

Visitation Prior to Service (no visitation notes)

Visitation Without Service (private farewell or graveside only)

Identification

No Visitation

Visitation Type:

Visitation :

Visitation with Minimal Preparation (Private)

Visitation with urn only until 8:30 P.M., Monday to Friday or until 5:00 P.M., Weekends or Holidays

Other

Visitation with embalming

Visitation (facilities):

Basic use of facilities 9a

Other

Visitation 1 Date:

Required at Crematorium By:

Visitation 1 Start Time:

Visitation 1 Start Time :

Visitation 1 End Time:

Date and Time:

After Hour Visitations (After 8:30 P.M.or after 5:00 P.M., Weekends or Holidays) Per Hour

Not an After Hour Visitation

Date and Time:

After Hour Visitations (After 8:30 P.M.or after 5:00 P.M., Weekends or Holidays) Per Hour

Not an After Hour Visitation

Same as Appointment Location

Visitation 1 Location:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Same as Appointment Location

Visitation 1 Location:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Public or Private?:

Public

Private

Public or Private?:

Public

Private

Number of People Expected to Attend:

Casket:

Open

Closed

Casket Location:

Special Music:

Yes

Video Equipment:

Funeral Home Video Equipment Required

Portable Display 58" Monitor Required

Other

Live-Streaming / Remote Participation / Video Recording:

Live-Streaming / Remote Participation / Video Recording NOTES:

Memorabilia Special Display Notes:

Arranger Notes:

Catering / Hostesses - Visitation?

Yes

Catering Options:

Serve Coffee & Cookies

Serve Coffee Only (no cookies)

No Coffee or Cookies to be Serviced

Catering Requested (as listed below)

Catering Details

To add additional items click on the plus sign

Special Notes for Caterer (food allergies, etc.):

Catering Ordered On:

Catering Ordered By / Notes:

Specify the number of hostesses for visitation

# of Hostess Required:

Hostess (Visitation)

Hostesses Confirmed :

Yes

If Known

Hostess/es Names:

Hostesses Arranged By:

Hostess Ordered by:

Hostesses Order Sent by :

Hostess Ordered Date:

Catering Notes :

Is there a second visitation, afterhours or all night visitation planned?

Yes

Visitation 2 Prior to Service?:

Visitation 2 - Prior to Service

Visitation 2 Details:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Visitation 2 Date :

Additional Visitation:

Extra Day of Public Visitation until 8:30 P.M., Monday to Friday or until 5:00 P.M., Weekends or Holidays

Extra Day of Private Family Visitation until 8:30 P.M., Monday to Friday or until 5:00 P.M., Weekends or Holidays

All Night Visitation 2 Rooms at Eastside Memorial Chapel or Chapel of the Bells

Visitation 2 Start Time:

Visitation 2 End Time:

Room Selections - OVERNIGHT:

All Night Visitation 1 Room at any location Monday - Friday

All Night Visitation 1 Room at any location Saturday - Sunday

All Night Visitation 2 Rooms at Eastside Memorial Chapel or Chapel of the Bells

Number of People Expected to Attend:

Casket Lid:

Casket Location:

Special Music:

Yes

Video Equipment:

Funeral Home Video Equipment Required

Portable 58" Display Monitor Required

Portable Video Equipment NOT Required

Other

Memorabilia Display Locations:

To be placed in chapel

To be placed in foyer

Place in visitation room

Other location

Memorabilia Special Display Notes:

Visitation 2 Notes:

Is there a third visitation?

Yes

Visitation 3 Details:

Address:

City:

Country:

State/Province:

Zip/Postal code:

Phone:

Visitation 3 Date:

Visitation 3 Start Time:

Visitation 3 End Time:

Number of People Expected to Attend:

Casket Lid:

Casket Location:

Special Music:

Yes

Video Equipment:

Funeral Home Video Equipment Required

Portable Display 58" Monitor Required

Portable Video Equipment NOT Required

Other

Memorabilia Display Locations:

To be placed in chapel

To be placed in foyer

Place in visitation room

Other location

Memorabilia Special Display Notes:

Identification Date:

Funeral Planner V1.4 2021

Funeral Planner V1.44 2021

Information on who has passed away that we are caring for.

Name as will be on FDSD

Below Is the Information of where they passed away

Do not use CARE OF or another family member’s address

Mother's Information - use given names for first name

Will

Legal Marital Status

Common Law

Funeral Home Family Contact

Contact 2

Contact 3

Primary Invoice To

Is a Second Invoice Required?

Obituary Information (online and newspaper)

List Newspaper Name followed by date to run obituary in the "PRODUCT LABEL" field

Announcement Later

Funeral Home Website Hosting Obituary & Condolences

Newspaper Obituary

List Newspaper Name followed by date to run obituary in the "PRODUCT LABEL" field

"Price" field must be $1 or greater to display on contract

Obituary Costs

For Office Use - Submitted (online & print)

Obituary Submitted?

Flight Costs

Transfer In / Out Fees

<<< Dressing, Cosmetology, Casketing) - Required with Embalming >>>

In respect for the deceased our staff will bath and dress the deceased in their own clothing.

<<< Thumbprint Impression Taken >>>

<<< DNA Preservation >>>

Below Is the Information about who will be contacted when the DNA capsule is received from Securigene in 4-6 weeks.

Visitation or Identification

Catering / Hostesses - Visitation?

Catering Details

Specify the number of hostesses for visitation

Is there a second visitation, afterhours or all night visitation planned?

Is there a third visitation?