Transport & Monitoring Services Report All reports are due within 24 hours of completed services.Client Name(Required) First Last Staff Name(Required) First Last Date of Service(Required) YYYY slash MM slash DD Report Type(Required) Random Transport Destination(Required) Time of Arrival(Required) Hours : Minutes AM PM AM/PM Time of Departure(Required) Hours : Minutes AM PM AM/PM DSE Client?(Required) Yes No Did the client make any purchases, withdraws, or deposits?(Required) Yes No If yes, detail below:Did the client have any packages delivered?(Required) Yes No If yes, what were the contents of the package/s?If yes, were they opened in front of staff?(Required) Yes No N/A Does the client have a cell phone?(Required) Yes No If yes, does the client have a smart phone?(Required) Yes No N/A Were any GPS issues encountered?(Required) Yes No If yes, detail below:Were any GPS locations added?(Required) Yes No If yes, detail below:Were any GPS locations refused?(Required) Yes No If yes, detail below:Did client refuse treatment or other community reintegration service expectations?(Required) Yes No If yes, detail below:Were there any contacts with community members outside of a professional capacity (verbal or non-verbal)?(Required) Yes No If yes, detail below:Was the client's use of technology solely for a pre-approved purpose (e.g. resume, job applications, etc.)?(Required) Yes No N/A If NO, detail below:Did the client exhibit any of the following behaviors?(Required) Fraternization/boundary concerns Threatening behavior (physical or verbal) Inappropriate sexual conduct Any other uncharacteristic or concerning behavior that made staff feel uncomfortable None of the above Please check all boxes that apply during your particular service.Note: For the above field labeled "Did the client exhibit any of the following behaviors?", the available checkbox options on the form are: Fraternization/boundary concerns; Threatening behavior (physical or verbal); Inappropriate sexual conduct; Any other uncharacteristic or concerning behavior that made staff feel uncomfortable; None of the above.If any box(es) other than "none of the above" are checked above, detail below:Were there any STAFF safety concerns as a result of client behavior?(Required) Yes No If yes, detail below:Were there CLIENT safety concerns as a result of client behavior?(Required) Yes No If yes, detail below:Did the client or staff observe any physical or mental health concerns?(Required) Yes No If yes, detail below:Did the client report any housing or property concerns?(Required) Yes No If yes, detail below:Additional InformationIncident Report Needed?(Required) Yes No Date Incident Report Submitted (if applicable): MM slash DD slash YYYY Acknowledgement(Required) I acknowledge the report submission above is accurate and to the truest of my knowledge.CAPTCHA
