WAM Appointment Notes & Risk Assessment

YOU MUST COMPLETE THIS FOR EVERY SESSION AND EVERY CONTACT WITH CLIENT.

Name of Client *

Name of Mentor *

Date of appointment *

Time of Appointment (24 hour clock) *

Hours

Minutes

Session Number *

Was the appointment attended? *

YESNODNA/CANCELLED

What was the intended method of contact, phone, skype, google meet, etc?

Appointment Notes:

IF THERE IS ANY RISK PLEASE DETAIL BELOW (CHECK FOR RISK AT EVERY APPOINTMENT) IF THE RISK IS MEDIUM ALSO COMPLETE A SAFE PLAN WITH THE CLIENT SEPERATE TO THIS DOCUMENT *

SUICIDAL IDEATIONSELF HARMURGENT MEDICAL ATTENTIONNONE OF THE ABOVE - N/A - UNABLE TO ASSESS

NOW ASSESS THE LEVEL OF RISK *

DETAILS OF THOUGHTS, PLAN OR INTENT OF SUICIDE/SELF HARM OR URGENT MEDICAL ATTENTION

NHS 111 ASSESSMENT LINK

111 Assessment Portal (click on link)

COPY AND PASTE THE ADVICE WHICH WAS GIVEN FROM THE NHS 111 ONLINE ASSESSMENT HERE:

GIVE CLIENT ADVICE FROM ASSESSMENT ABOVE: IS THE CLIENT ACTING ON THE ADVICE?

Based on the above, do you consider that the client is in danger, or a further risk to themselves or others?

DETAILS OF ANY ACTION I TOOK MYSELF: EXAMPLE: FROM THE 111 ASSESSMENT

Is there a Complaint, Safeguarding or Incident from this session? *

CSI REFERENCE NUMBER

Outcome of appointment *

Next session booked as plannedDischarged DNA/CANDischarged Work CompleteDischarged Other – please note below – or write N/A if neededNot Applicable [other] detail below

Other discharge reason / other outcome if required if not required enter N/A

Date of Submission *

Time of Submission (24 hour clock) *

Hours

Minutes

Terms & Conditions

Counselling – Support Line – Wellbeing & Mentoring – LGBT+ Awareness Training,