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Run: Street Outreach Encounter Log

A street outreach encounter log for recording shift details, locations covered, people contacted, services offered, and follow-up needs. Use it to keep outre...

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Shift & Team Information

Shift Date (required)

Date on which this outreach shift took place.

Shift Start Time (required)

Shift End Time (required)

Outreach Worker Name (required)

Additional Team Members Present

Leave blank if you were the sole outreach worker.

Program / Organization (required)

Shift Type (required)

Outreach Locations Covered

Primary Outreach Zone / Neighborhood (required)

Specific Sites / Encampments Visited (required)

Include cross-streets, park names, or known encampment identifiers. Do not include PII of residents in this field.

New Sites Identified This Shift (required)

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 (required)

Count of unique individuals spoken with during this shift.

New Contacts (First Encounter) (required)

Individuals contacted for the first time — not previously known to your program.

Returning Contacts (Previously Known) (required)

Individuals Who Declined Engagement (required)

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 (required)

Add one entry per individual contacted. You may use initials, a client ID, or 'Anonymous' to protect client privacy.

Client ID / Initials / Anonymous (required)

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 (required)

Time of Encounter

Contact Type (required)

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 (required)

Select all needs identified during this encounter.

Services / Resources Offered (required)

Services / Resources Accepted (required)

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? (required)

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? (required)

Shift Debrief & Supervisor Notes

Shift Summary (required)

Barriers or Challenges Encountered

Select any barriers that affected outreach effectiveness during this shift.

Supply Inventory Note

Outreach Worker Wellbeing Check (required)

Street outreach is emotionally demanding work. Please indicate your current wellbeing so supervisors can offer appropriate support.

Additional Notes for Supervisor

Outreach Worker Signature (required)

By signing, you confirm that the information in this log is accurate to the best of your knowledge.

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