Notification of individual or family sleeping outdoors
Are you concerned about someone sleeping outdoors? Outreach and support services are available for people living on the streets and in other public places.

Please help us to assist people who are sleeping in places not meant for human habitation (such as cars, parks, woods, sidewalks, abandoned buildings) by letting us know where they are located. Our region's outreach team will attempt to make contact with the individual or family.

Please note that the outreach team works to build a relationship with individuals who may be uncomfortable seeking services. Making these connections takes time. Other individuals may already have somewhere to stay. Therefore, you may still see the individual or family after completing this form.

Call 911 if a person is currently ill, in danger, or creating a dangerous situation.

The form below can be used to notify outreach of individuals for the following localities: Town of Ashland, Counties of Chesterfield , Charles City, Goochland, Hanover, Henrico, New Kent, Powhatan, and City of Richmond.

Locality where individual was seen
Address, street, or intersection where you saw the individual or family
Your answer
Location Description
Please provide as much detail as possible about the location where you have seen the person or family (e.g. in a yellow tent behind the WalMart parking lot)
Your answer
Date you saw the individual or family
Time of day you saw the individual or family
Individual or family's name, if known
There is no need to approach someone you don’t know to ask them.
Your answer
Please provide a description to help outreach workers identify the individual.
Your answer
What was the individual or family doing? (sleeping on a bench, panhandling, etc.)
Your answer
Your Name
Your answer
Your Organization
Please let us know if you are with a specific community agency, congregation, group, or if you are a concerned community member.
Your answer
Best way to contact you if more information is needed
Your answer
Any other helpful information or comments
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service