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ABSENCE WITHOUT LEAVE CHECKLIST
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DATE
MM
/
DD
/
YYYY
TIME
Time
:
AM
PM
HOUSE
Your answer
CLIENT NAME
Your answer
# of Missed Curfews Before
Your answer
Step Description
Client Misses Curfew
Call & Text Client
Send Nightly Housing Stat Report
Client Returns Home
Send OOH Group Text
Contact Hospitals (Name/Number)
Contact Jails
Contact Mental Health
Engage Client Advocate
Inventory & Pack Clothes
Contact Emergency Contact
Meet with Clinician/Rehab Case Worker
Discharge Package
QC Follow Up
Other:
Clear selection
Action Taken
Your answer
Date Completed / Initial
Your answer
Remarks
Your answer
For more information,
OOH Training Department : 443.805.8927
OOH Main Office 1.855.9. OOHHOPE (1.855.966.4467)
PW@OrganiationOfHope.org
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