Emergency Call Sheet
Date
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Month
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Day
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First Name:
Last Name:
Phone Number:
Phone Tipsheet/ Incoming DV Calls
Are you in any harm or physical danger? If so, are you safe?
Do you need me to call the police?
Do you have a restraining order?
If so, do you need help in obtaining one?
Where do you live?
Is it safe for me to speak to you on this at this number?
If not, is there a safe number where you can be reached?
Do you have children under 18? If so, please list Sex/Age.
How many? Have they been abused?
Is there anything more you would like to add to this conversation?
Email for additional resources:
Notes:
Safe Passage Staff Name:
Submit
Should be Empty: