Street Outreach Encounter Log

Records date, location, individuals contacted, services offered, and accepted on a street outreach shift. Used by outreach teams to track engagement with unsheltered people.

Shift & Team Information

• Shift Date
  Date on which this outreach shift took place.
• Shift Start Time
• Shift End Time
• Outreach Worker Name
• Additional Team Members Present
  Leave blank if you were the sole outreach worker.
• Program / Organization
• Shift Type

Outreach Locations Covered

• Primary Outreach Zone / Neighborhood
• Specific Sites / Encampments Visited
  Include cross-streets, park names, or known encampment identifiers. Do not include PII of residents in this field.
• New Sites Identified This Shift
• New Site Description and Location
• Site Photo (Optional)
  Attach a photo of the site if helpful for team navigation. Do NOT photograph individuals without explicit consent.

Encounter Summary — Shift Totals

• Total Individuals Contacted
  Count of unique individuals spoken with during this shift.
• New Contacts (First Encounter)
  Individuals contacted for the first time — not previously known to your program.
• Returning Contacts (Previously Known)
• Individuals Who Declined Engagement
  Count of individuals who were approached but declined to engage. Respecting refusal is standard practice.
• Total Supply Kits / Items Distributed

Individual Encounter Records

• Encounter Records
  Add one entry per individual contacted. You may use initials, a client ID, or 'Anonymous' to protect client privacy.
• Client ID / Initials / Anonymous
  Use your program's assigned client ID if available. Initials or 'Anonymous' are acceptable. Do NOT record full names unless required by your program policy.
• Encounter Location
• Time of Encounter
• Contact Type
• Approximate Age Range
  Estimate only — do not ask for date of birth unless clinically required.
• Gender Identity (Self-Reported, Optional)
  Record only if voluntarily disclosed by the individual.
• Presenting Needs Identified
  Select all needs identified during this encounter.
• Services / Resources Offered
• Services / Resources Accepted
  Select only what the individual accepted. Declined services are not recorded here — refusal is always respected.
• Referral Agency / Program Name
  If a referral was made, record the receiving agency here.
• Encounter Notes
  Do not record sensitive health diagnoses, substance use details, or other protected information beyond what is necessary for continuity of outreach.

Safety & Critical Incidents

• Were any safety incidents or critical situations encountered?
• Type of Incident(s)
• Incident Description
  Be factual and objective. This record may be reviewed by supervisors and used in incident reporting.
• Was a Supervisor Notified?
• Is Follow-Up Required?

Shift Debrief & Supervisor Notes

• Shift Summary
• Barriers or Challenges Encountered
  Select any barriers that affected outreach effectiveness during this shift.
• Supply Inventory Note
• Outreach Worker Wellbeing Check
  Street outreach is emotionally demanding work. Please indicate your current wellbeing so supervisors can offer appropriate support.
• Additional Notes for Supervisor
• Outreach Worker Signature
  By signing, you confirm that the information in this log is accurate to the best of your knowledge.