Tell us about a rough sleeper

If you see and are concerned about someone who is rough sleeping, please tell us. Please help us by providing as much information as possible.

Email us if you wish to discuss a rough sleeper – office@canaan-trust.co.uk

REPORT ON A ROUGH SLEEPER
Description of rough sleeper and their location

Name (if known):
Age (approx)
Ethnicity
Gender	MaleFemaleUnknown
Hair Colour	shortlongbaldfacial
Approximate height
Other identifying features (colour of clothing etc)
Location/area
Length of time at location (if known)
What time(s) are they usually there?
Additional information
Please give details if they are exhibiting any concerning behaviour (threatening verbal/physical behaviour)
Are you aware of any contact which may have been made with Local Council	YesNo
Please provide any information which would enable staff to contact the individual safely.
Is the individual concerned aware of this referral	YesNoDont know
Are you aware of any specific support needs?	Drug/substance usePersonal CareElderlyChronic illnessAlcohol usePhysical disabilityYoung
Please provide your own contact details (optional)
Name
Contact number
Email address
We will not retain your information for any purpose other than confirming referral and to seek further information if deemed helpful.
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