Youth Runaway Crisis Assessment Sheet
Youth Information
Name
Age
Gender
Contact Information
Date of Assessment
Current Situation
Current Location
Duration Away From Home
Reason for Leaving
Family / Home Information
Family Members Contacted
Home Environment
Risks & Safety
Physical Health Concerns
Mental Health Concerns
Immediate Risks (e.g. Safety, Exploitation, Substance Use)
Support & Resources
Existing Support Systems (Friends, Agencies, etc.)
Referrals/Actions Needed
Assessor Information
Assessor Name
Assessor Role/Title
Contact