Support Line Record Form

CALL HANDLER NAME(required)

Clients First Name (required)

Clients Last Name(required)

Clients Phone Number(required)

Check client is resident at the address listed on the call schedule is this the case Yes

No – enter current location below

Clients First Line of Address(required)

Clients Post Code(required)

This call was (required) Incoming – the client called us

Outgoing – we called the client

If the call was outgoing – did they answer?(required) Yes

No / Not Applicable / Incoming Call NB you will need to put N/A for some other options lower on form

Does the client require a counselling referral to us? EXPLICITLY ASK THIS DO NOT MAKE ASSUMPTIONS(required) Yes – put their email in box below

No / They are already in counselling service / N/A

Email if client is going to counselling

Do they require further support line follow up calls? EXPLICITLY ASK THIS DO NOT MAKE ASSUMPTIONS(required) Yes – please agree these with the client and inform TL

No – support line call backs not required – N/A

CHECK FOR SUICIDE AND SELF HARM – ask the client if they are currently feeling suicidal or that they may hurt themselves(required) ZERO RISK – they have no thoughts or plans of self harm or suicide – NO ACTION NEEDED

LOW RISK – they have current or transient thoughts of suicide or self harm but not plan or intent – GIVEN VERBAL ADVICE TO REFER TO 111/999 IF THOUGHTS PERSIST OR PLAN OR INTENT DEVELOPS

MEDIUM RISK – they have thoughts of self harm or suicide and there is a plan – REFER CLIENT TO 111

HIGH RISK – they have thoughts of suicide or life threatening self harm, a plan and they have active intent – REFER CLIENT TO 999 IMMEDIATELY

Client did not answer or call ended unexpectedly – could not assess risk

Details of any suicide or self harm risk, include here preventative measures you have undertaken, such as transfer to 111 or 999, or verbal advice. If not applicable, enter not applicable. If not assessed put N/A(required)

Indicate here areas covered during the call(required) Sexuality

Gender

Loneliness / Isolation

Anxiety / Depression

Family Problems

Relationships

Addictions / Substance Dependence

Work Related / Employment Issues / Unemployment

Financial Issues

COVID Related Issues

Health / Physical

Health / Mental

Legal Issues / Including Family Disputes / Custody etc / Other court appearances

Domestic Violence

Sexual Assault

Hate Crime – IF THIS IS THE CASE PLEASE REPORT VIA 101/999 OR OUR CASUAL HATE CRIME REPORTING TOOL ON OUR VOLUNTEER PORTAL AND SUPPORT LINE PORTALS

Victim of other crime

ABUSIVE CALLER

Other – detail in notes section below – do not write anything else – see note below

Is there a Safeguarding Issue from this call?(required) Yes – detail this below in notes section

No / N/A

NOTES – this is only to be used for recording DNA's or CSI events. DO NOT write a description of the call here! If there is additional info to feedback please use de-brief with TL.