Domestic Violence Shelter Admission Checklist

Personal Information

Name
Contact Number
Date of Birth
Emergency Contact

Admission Documents

Photo ID
Referral/Intake Form
Consent Forms Signed
Personal Belongings Logged

Shelter Orientation

Reviewed Shelter Rules
Given Tour of Facilities
Assigned Room/Bed
Emergency Exits Shown

Immediate Needs Assessed

Medical Attention Needed
Food/Drinks Provided
Hygiene Items Provided
Children's Needs Addressed

Notes