Northeastern Nevada SAFE - Advocate Report
This form will be used to record visitations done by SAFE Volunteers. 

Please fill out to the best of your ability and with full honesty. These reports will remain between the Volunteer and the Executive Director. 

Thank you!
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Name *
Email/Phone Number
Name of Protected Person
Date of Visit
MM
/
DD
/
YYYY
How long was your visit? *
How was the Protected Person's mood? *
Angry/Upset/Sad
Happy/Talkative
What activities did you engage in during the visit? *
How was the Protected Person's hygiene? *
Dirty/Needs Attention
Clean/Well Taken Care Of
What was your overall perspective of the visit? *
Do you have any comments, issues, or concerns? *
Are you still feeling comfortable with your assigned Protected Person? *
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