Crisis counselors are required to document the services they provide. Collecting data on disaster survivors and the services they receive supports ongoing evaluation of your CCP.
Basic Data Collection Forms and Training
There are three basic forms submitted to CCP team leaders after each encounter.
Please use the following forms if your ISP or RSP began on or after September 15, 2022.
- Individual/Family Encounter Log (OMB 2025) (PDF | 187 KB)
- Group Encounter Log (OMB 2025) (PDF | 219 KB)
- Weekly Tally Sheet (OMB 2025) (PDF | 276 KB)
Please use the following forms if your ISP or RSP began on or before September 14, 2022.
- Individual/Family Crisis Counseling Services Encounter Log (OMB 2022) (PDF | 177 KB)
- Group Encounter Log (OMB 2022) (PDF | 237 KB)
- Weekly Tally Sheet (OMB 2022) (PDF | 245 KB)
Access the Basic Forms Training for crisis counseling staff to learn how to fill out each form. The training is about 55 minutes. CCP Data Forms: Frequently Asked Questions (PDF | 209 KB) is also helpful.
These forms are also available in Spanish. Please use the following forms if your ISP or RSP began on or after September 15, 2022.
- Registro de visita individual o familiar para servicios de consejería en tiempos de crisis (OMB 2025) (PDF | 268 KB)
- Registro de la visita de grupo (OMB 2025) (PDF | 255 KB)
- Hoja de cómputo semanal (OMB 2025) (PDF | 287 KB)
Please use the following forms if your ISP or RSP began on or before September 14, 2022.
- Registro de visita individual o familiar para servicios de consejería en tiempos de crisis (OMB 2022) (PDF | 215 KB)
- Registro de la visita de grupo (OMB 2022) (PDF | 188 KB)
- Hoja de cómputo semanal (OMB 2022) (PDF | 305 KB)
Assessment and Referral Tools and Training
Service providers also use advanced tools known as Assessment and Referral Tools.
Please use the following forms if your ISP or RSP began on or after September 15, 2022.
- Adult Assessment and Referral Tool (OMB 2025) (PDF | 219 KB)
- Adult Assessment and Referral Tool Response Card (PDF | 159 KB)
- Child/Youth Assessment and Referral Tool (OMB 2025) (PDF | 244 KB)
- Child/Youth Assessment and Referral Tool Response Card (PDF | 74 KB)
Please use the following forms if your ISP or RSP began on or before September 14, 2022.
- Adult Assessment and Referral Tool (OMB 2022) (PDF | 296 KB)
- Adult Assessment and Referral Tool Response Card (PDF | 159 KB)
- Child/Youth Assessment and Referral Tool (OMB 2022) (PDF | 364 KB)
- Child/Youth Assessment and Referral Tool Response Card (PDF | 74 KB)
These forms are also available in Spanish. Please use the following forms if your ISP or RSP began on or after September 15, 2022.
- Herramienta para la evaluación y remisión de adultos (OMB 2025) (PDF | 261 KB)
- Tarjeta de respuestas (para entregar a las personas antes de la evaluación) (PDF| 64 KB)
- Herramienta para la evaluación y remisión de niños y jóvenes (OMB 2025) (PDF | 265 KB)
- Tarjeta de respuestas (PDF | 62 KB)
Please use the following forms if your ISP or RSP began on or before September 14, 2022.
- Herramienta para la evaluación y remisión de adultos (OMB 2022) (PDF | 214 KB)
- Tarjeta de respuestas (para entregar a las personas antes de la evaluación) (PDF | 64 KB)
- Herramienta para la evaluación y remisión de niños y jóvenes (OMB 2022) (OMB 2022) (PDF | 302 KB)
- Tarjeta de respuestas (PDF | 62 KB)
These tools collect data on people who are experiencing serious reactions, or who have encountered service providers three or more times. Training on how to use Assessment and Referral Tools is presented in three parts:
- Section 1 provides an overview of CCP Assessment and Referral Tools and their purpose. This training is about 10 minutes.
- Section 2 explains how to complete the Adult Assessment and Referral Tool and how to use the results to make appropriate referrals. This training is about 20 minutes.
- Section 3 explains how to complete the Child/Youth Assessment and Referral Tool and use the results to make appropriate referrals. This training is about 30 minutes.
Feedback Surveys and Forms
Feedback from disaster survivors and service providers helps grantees improve CCP services in real time and keep program goals on track.
Participant Feedback
Use the Participant Feedback Survey (OMB 2025) (PDF | 335 KB) to collect feedback from disaster survivors who have received CCP services. This survey is also available in Spanish (OMB 2025) (PDF | 265 KB).
Use the following resources to help you collect feedback from CCP participants:
- Participant Feedback Survey: Guidelines for Trainers (PDF | 115 KB)
- Participant Feedback Survey: Guidelines for Counselors (PDF | 97 KB)
- Participant Feedback Survey: Cover Letter (DOC | KB)
Service Provider Feedback
Use the Service Provider Feedback Form (OMB 2025) (PDF | 380 KB) to collect feedback from CCP crisis counselors. This survey is also available in Spanish (OMB 2025) (PDF | 231 KB).
Use the following resources to help you collect feedback from CCP service providers:
- Service Provider Feedback Form Task Timeline (PDF | 212 KB)
- Boilerplate Service Provider Feedback Form Announcement (DOCX | 23 KB)
- Boilerplate Service Provider Feedback Form Announcement: Paper Version (DOCX | 24KB)
- Boilerplate Service Provider Feedback Form Cover Letter (DOCX | 31 KB)
- Boilerplate Service Provider Feedback Form Cover Letter: Paper Version (DOCX | 33 KB)
- Boilerplate Service Provider Feedback Form Thank You/Reminder (DOCX | 24 KB)