ECO-04
FORUM HOUSING ASSOCIATION
POLICE CONTACT RECORD SHEET
1:
Name of staff member: Project: Date of Police contact / /
Time of Police contact (use 24hr clock): Start time: Finish time:
Name of Police Officer(s) / ID Numbers:
Are you recording one of the following: (please tick the appropriate box)
i - An outgoing phone call to the Police o ii - An incoming phone call from the Police o
iii - Police Officer(s) visit to the Project o iv - A staff member visiting a Police Station o
Where applicable; was the phone call an: Emergency 999 o Non- Emergency 101 o N/A o
Where applicable; what was the name of Police Station visited: N/A o
If this contact was in relation to an incident / disclosure; then what is the NOR reference No:
2. Was this Police contact in relation to a service user(s) Yes o No o
If yes, then what is the name of the service user(s):
3: Reason for the phone call / visit: (reference any NOR Report Number (H&S-01) that will provide additional information)
4: Outcomes and actions: To be completed by a staff member.
If this contact was in relation to a service user(s), then this record must provide a clear link to any risk assessment and support plan updates. Please tick to confirm that the following actions have been completed.
The service user’s risk assessment has been updated: Yes o No o N/A o
A copy of this record has been placed in the service user’s file(s): Yes o No o N/A o
*Please pass on this form to the Departmental Manager, Service Manager or Team Co-ordinator.
5: The Departmental Manager, Service Manager or Team Co-ordinator must sign to validate the report and to confirm that appropriate actions have been put in place to eliminate, minimise or manage the risk(s). Where necessary, all outcomes from this report have been recorded in the service user’s support plan and file.
Print Name: Sign: Date: / /
eco-04-police contact record sheet (v2-03/2013)