Redline Animal Shelter Intake Form with airSlate SignNow

Redline animal shelter intake form

this video is part of a series of videos intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter client sign-in form is a critical record for the operation of every congregate shelter that we open this forum is intended to maintain a current accurate list of which clients are physically inside the shelter at any given moment every shelter has a prepared evacuation plan which will outline what to do if the building has to be evacuated the plan will designate a meeting place for all clients and staff and visitors where the shelter manager will make sure everyone is out of the shelter which means that the shelter manager has to know who was inside before the emergency this form combined with the separate shelter staff sign-in form and shelter visitor sign-in form has that information this form is maintained at the registration desk which everyone must pass on their way into or out of the shelter each client is asked to enter their information as they enter or exit since the form contains personal information it should not be left at the registration desk if no staffer is present it must be stored in a secure manner and location usually in the shelter logbook the top row of the form should look very familiar to you it contains the date this page was started the identifying number of the Disaster Response and the name or location of the shelter this information is entered by the registration worker assigned to the registration desk when the previous page is full and this one is started the registration desk in every shelter is located at a choke point a place everyone must pass to enter any part of the shelter or to leave as each client passes in either direction he or she is asked to fill out this form one family member may enter the information for the whole family but each line is intended for a single person time in if the client is entering the shelter the time is recorded the new or returning column indicates whether or not the client must undergo the intake process or has already done so timeout a client leaving the shelter marks the time here the temporary or final exit information is important we need to know whether this client will return which impacts our feeding and dormitory operations as well as the midnight count of shelter residents contact information it's important that we be able to contact the client with information or to track their whereabouts this is almost always the clients cell phone number notes is the place to record additional information that's relevant the clients destination anticipated return and so on the shelter client sign in form is a critical snapshot of the current client population in our shelter this video is part of a series intended to give you an overview of the forms used by the American Red Cross in our shelter operations the client storage agreement form is used to lay out the terms under which we will accept a client's personal belongings for temporary storage the forum provides the client with a written receipt for his or her personal belongings which the Red Cross has agreed to store temporarily clients arrive at our shelters at what is probably one of the most terrible moments in their lives their homes are uninhabitable and they turn to us for help often the clients will arrive at our shelter with everything they were able to gather up before leaving home and they will ask us to store their belongings for them in many cases we will be able to accommodate this request this form is a summarized inventory of the clients belongings and also confirms to us exactly who has the owner's permission to access those belongings this is the top half of the shelter client storage agreement and it's filled out by the Red Cross staffer who is accepting the belongings for temporary storage the top box contains identifying information the date we accept the belongings the disaster response number the clients cot number in the dormitory the shelter location and where we will store the belongings it also identifies the client who will sign the form and one additional person who is authorized to access the belongings we ask for two telephone numbers if available the second box is the brief inventory of belongings the number of boxes plastic tubs bags and other containers were being asked to store note that we do not inventory the containers specific contents if at all possible each container should be sealed with tape before we accept it this is the bottom half of the shelter client storage agreement it lays out the limits of our responsibilities and lists several specific items which the client agrees are not in any of the containers it's important that the client actually reads and understands all six terms detailed here the clients signature at the bottom completes this form which is then stored with the clients registration form in a secure place for more information on how and where we can store client belongings search the exchange for caring for client belongings tip sheet this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter dormitory registration form is the record of the client intake interview conducted when someone first enters our shelter the form collects information about a client who will use our dormitory including information about the family members who arrived at the same time the intake interview allows the Red Cross staffer an opportunity to assess the client's needs which can be met by our other services such as disaster spiritual care disaster health services disaster mental health disability integration disaster assessment and service to Armed Forces as well as to our external partners such as the Federal Emergency Management Agency the Department of Defense and Veterans Administration as part of the interview the Red Cross staffer will also be able to identify a client who has immediate needs such as isolation personal assistance or dietary restrictions allergies or religious practice this is the top half of the shelter client dormitory registration form the top line contains the date of registration the disaster response number and the name of the shelter the reception staffer fills in this line of information the top box contains valuable guidelines for the registration staffer and two important questions to be asked early in the interview the answers to these two questions will identify a client who needs immediate help from one of our support departments or from an outside partner a positive response here to either question should be reported to your supervisor or to the shelter manager as soon as possible the household information is self-explanatory it's important that all boxes be filled in no blanks enter either a zero or not applicable or unknown if necessary this is the bottom half of the shelter client dormitory registration form it's important that if possible the form is filled out by the registration staffer this gives you the opportunity to observe the clients demeanor to gauge the possibility that he or she needs immediate assistance from one of our Red Cross support departments or outside partners the top box records information for each member of the clients family who arrives at the same time additional members of the family who arrived later should be added to this form at that time we ask for the name age gender and arrival date for each member of the family the cot number will be filled in by the dormitory supervisor enter whether or not the client and family members are willing to volunteer to help run the shelter the right two columns are filled in when the client and family members leave for the last time the final three questions in this box are important the first one is intended to identify anyone who is required to report to law enforcement such as a parolee or a person convicted of a sexual offense a positive answer to this first question should be reported to the shelter manager be the client and family leave the registration desk in most cases this question will elicit a puzzled reaction from the client who doesn't really understand the question we accept that as a No the second question allows us to identify someone who might be eligible for assistance from the Department of Defense or the Veterans Affairs agency the third question is really a statement the Red Cross needs permission from the client in order to share his or her information with other disaster agencies such as FEMA state emergency management or county and city ems agencies we only share the information when we are seeking special assistance for the client but please note that a yes is not required to register a no is acceptable and will be respected the clients signature and the date the registration staffers signature and printed name complete the form this form and the information it contains is never shared with anyone who is not a Red Cross person who needs the information and who is authorized to see it since the form obviously contains personal and confidential information it is kept in a secure location usually in the registration folder or book in the Red Cross shelter office this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter inventory form is used to provide a snapshot of all Red Cross and external partner equipment and material physically at the shelter the Red Cross deploys hundreds of thousands of dollars in equipment and supplies to support a major disaster operation keeping track of everything is not only good management it can represent a major financial saving to the organization if we don't have to buy a replacement item we save the money when a shelter is opened that operation has jump-started with everything needed for the anticipated population everything from cots and blankets to clipboards and pencils and coffee pots multiply that inventory by the dozens of shelters we open during a level 7 operation the largest that we do and we're talking about real money it is the responsibility of the shelter manager and the Red Cross staffers to keep track of that inventory and the shelter inventory form is the main tool for that task we start when the shelter is open and create the first one we create a new one on a schedule set by the shelter manager every two days every week whatever the DR needs and we create a final one at shelter closing the completed forms are turned in at headquarters by the shelter manager after the shelter closes this is the shelter inventory form we've removed blank lines in the middle of the page at the red line at the top of the form we write the date of this inventory the disaster response number and the name of the shelter the staff are conducting the inventory fills in this information the top box represents the parameters of this specific inventory whose equipment and supplies were counting when we're doing the counting and what areas of the shelter were inspecting to get the counts shelter staffers will normally fill out one of these forms for each source of equipment obviously most of our stuff will come from the Red Cross but we have many external partners who will lend equipment to the shelter to be used by the clients large screen TVs washer dryers cell phone chargers etc to use this set of circumstances we would fill out for inventory forms one each for the Red Cross for the television sets the washer dryers and a fourth one for the cell phone chargers each line of the form is intended for a single item we record the name of the item the quantity we have on hand and what's going to happen to it when the shelter is closed this sample form would be used for Red Cross equipment and supplies these items will all be returned to logistics when the shelter is closed maintaining this count as accurately and completely as possible will make a big difference to the Red Cross bottom line and to make sure equipment loan to us by external partners will be returned where necessary that will make our external partners happy which means they'll be there for us the next time around this video is part of a series intended to give an overview of the forms used by American Red Cross in our shelter operations the shelter Log form is used to record anything and everything that happens at the shelter there are two main uses for this log form as a shelter log which records the usual and unusual happenings in the daily life of a shelter such as staff changes deliveries donations success stories lessons learned in short it's the diary of the operation but this form is also used as a managers log it serves as a record of running the shelter staff issues personnel problems client complaints solutions arrival of unaccompanied minors medical issues everything that in the shelter managers mind rises to the level of talk to my boss about this both versions of this form are considered confidential and as such must be stored in a secure manner and location additionally it should be noted that the managers log is only to be shared with the supervisor of the other shift and with an incoming replacement manager this is the shelter log form in this case it contains entries relevant to the general operation and the manager of the shelter to illustrate what would be written in both versions the top box records the date this page was started the number of the disaster operation and the name of the shelter the Red Cross staffer assigned to maintain this log by the shelter manager or the shelter manager him or herself will fill in this line the form is simple in an attempt to allow details to be entered about the whole gamut of issues that arise in the life of a shelter it has only three columns the date and time of the entry details of the entry and what follow-up is needed let's take the first entry as an example of what would be written in the shelter managers log shelter manager Bill Jones wrote this entry at 2:30 a.m. on May the 25th the Smith family arrived at the shelter and registered during the intake interview James Smith said that yes was required to report to law enforcement when he spends the night somewhere other than his own bill called his boss the headquarters sheltering manager and reported the information bill was promised to call back with further instructions but in the meantime they agreed that the Smith family should be accommodated in a private room away from the main dormitory in this case bill assigned them to room one one four and follow-up is required the information is now recorded the actions taken are noted and it's in the log as an open issue now look at line four at 2:00 p.m. the same day the day shelter manager received a call from the HQ sheltering manager advising her that James Smith is not required to report to law enforcement so she moved the family out of room 114 back into the general dormitory issue closed it bears repeating that these two entries would be in the shelter managers log they are confidential and will be kept private the other three entries on lines 2 3 & 5 are typical of the entries made in the shelter log when a disaster operation is concluded and the volunteers scattered to the four corners of the United States the shelter managers logs and the shelter logs are studied by Red Cross headquarters personnel that's how the organization learns to do better the next time around and unfortunately there will be a next time around this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter referral Log form is used to record all referrals made by shelter staffers to other Red Cross support teams on a major disaster operation sheer numbers make keeping track of clients a difficult task when it seems that every client requires assistance from our fellow Red Cross volunteers something is bound to fall through the cracks this form helps make sure that that doesn't happen whether the client needs a referral to disaster Spiritual Care disaster health services disaster mental health disability integration disaster assessment whatever the other team is we can provide the referral and keep track of it on this form this is the shelter referral log form several blank lines have been removed at the diagonal red line for clarity the top information should be very familiar to you by now the date this page was started the official identification number of the disaster operation in the name of the shelter the Red Cross staffer assigned to maintain this log will fill in this line each line of boxes on the form is intended to contain the information for one client or one family unit referred to another department date and time of referral the clients name the clients cell phone number a brief general note of the client's needs and the team to whom the client was referred to cautions first we do need a correct cell phone number the other team can't help if they can't get a hold of the client and second keep the client need notes general don't write a diagnosis don't say schizophrenic say emotional support we're shelter volunteers we are not licensed physicians there's no column on this form for the name of the shelter staffer doing the referring nor the name of the person on the support team to whom the staffer talks to initiate the referral but it's a good idea to add that information to the client needs box and if you take another line to do that so be it this form contains personal and confidential information and therefore needs to be kept in a secure location this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operation the shelter shift inspection form is used to record a snapshot of the shelter condition twice a day at each shift change when two teams of two volunteers each are running a shelter keeping track of everything is relatively simple when it's a mega shelter with hundreds of volunteers staffers and nine thousand clients that's a whole different proposition we normally run our shelters on two 12-hour shifts and the incoming and outgoing shift supervisors will do a walk around together and chat about what happened in the last twelve hours this form records the observations made by these two supervisors a new scratch on the gym floor outside signs ruined by rain a broken door handle a leaky faucet in the ladies room it's all relevant to the shift inspection log this is the top half of the shelter shift inspection form it begins with the date of the inspection the number of the disaster response and the name of the shelter the top box notes the time of the inspection and the people doing it the incoming shift day or night the time of the inspection and the two people who conducted the first box covers some general items and requires only a yes/no or not applicable response note that all no responses need to be explained the space for that is in the next slide showing the bottom half of the form this is the bottom half of the shelter shift inspection form it contains another 13 more specific items this time about the interior of the shelter space again yes no are not applicable are the answers at the bottom is a box for notes and explanations for all no responses to any question on the whole page top half or bottom half and remember if an item is serious enough to be entered in the shift' inspection log it's important enough to bring to the attention of the shelter manager who will in all probability discuss it with the HQ sheltering manager this form is filed in the sheltered logbook and kept in the shelter office this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter staff sign-in form is a critical record for the operation of every congregate shelter we open the form is intended to maintain a current accurate list of which staffers are physically inside the shelter at any given moment every shelter has a prepared evacuation plan which will outline what to do if the building has to be evacuated the plan will designate a meeting place for all clients and staff where the shelter manager will make sure everyone is out of the shelter which means the shelter manager has to have that information about who is inside the shelter before the emergency happened this form combined with the separate shelter client sign-in form has that information the form is maintained at the registration desk which everyone must pass on their way into or out of the shelter each staffer is asked to enter their information as they come in or leave since the form contains personal information it must be stored in a secure manner and location usually in the administration kit in the staff office this is the forum the top row should look very familiar to you as it contains the date this page was started the identifying number of the disaster response and the name or location of the shelter this information is entered by the registration worker assigned to the desk when the previous page is full and this page has started the registration desk in every shelter is located at a choke point a place where everyone must pass to enter any part of the shelter or to leave as each staffer passes in either direction he or she is asked to fill out this form each line is intended for a single person name ID position the first three columns are for the staffers name Red Cross ID badge number and assigned to position on the shelter staff time in time out and hours worked this provides a daily record of this staffers hours lodging and transportation this last column has information that is needed by logistics to keep track of the number of rental cars and hotel rooms that the Red Cross is paying for the shelter staff sign in form a critical snapshot of the current staff population in our shelter this video is part of a series intended to give an overview of the forms used by the American Red Cross in our shelter operations the shelter visitor and media sign-in form is a critical record for the operation of every congregate shelter we open the form is intended to maintain a current accurate list of visitors who are physically inside the shelter at any given moment every shelter has a prepared evacuation plan which will outline what to do if the building has to be evacuated the plan will designate a meeting place for all clients and staff and visitors where the shelter manager will make sure everyone is out of the shelter which means that the shelter manager has to have that information about who was inside the shelter before the emergency happened this form combined with the separate shelter client and shelter staff sign-in forms has that information this form is maintained at the registration desk which everyone must pass on their way into or out of the shelter every visitor is asked to enter their information when they arrive or leave since the form contains personal information it must be stored in a secure manner and location usually in the administration kit box in the staff office this is the form itself the top row should look very familiar to you it contains the date this page was started the identifying number of the disaster response and the name or location of the shelter this information is entered by the registration worker assigned to the desk when the previous page is full and this page is started the registration desk in every shelter is located at a choke point a place everyone must pass to enter any part of the shelter or to leave as each visitor arrives or leaves he or she is asked to fill out this form each line is intended for a single person first rule no visitors may enter the dormitory without permission from the shelter manager and the approval of all clients present in the dormitory visitors may have access to the public areas of the shelter but must always be accompanied by a Red Cross staffer this form is also used to record visits by members of the media to whom special protocols and some special rules apply no recordings may be made audio or video within the dormitory and elsewhere only with the prior knowledge and consent of the shelter manager when any member of the media arrives the shelter manager is to be notified immediately and will handle the media visitors from there it's important to note that no client may be recorded by accident even or incidentally without their express consent again when in doubt ask your supervisor or the shelter manager information on the form date name time in time out ask the visitor to fill this out himself or herself organization and contact information in the case of a family visitor this is the name of the client they wish to visit in the case of the media it's the name of the outlet they represent the newspaper the channel or the radio station get a business card from anyone in the media name of escort follow up needed and notes no visitor may pass the registration desk into the shelter into any part of the shelter without an escort period no exceptions call your supervisor or shelter manager and request that an escort be assigned and sent to the registration table then put the name of that escort into this form