Vulnerable Person Questionnaire. Please enable JavaScript in your browser to complete this form. - confirm consent. Your Name *FirstLastYour Role *e.g. Housing Manager, Family MemberPhone Number *Email Address *Property Address *Is this a multi-occupancy building ie care home, sheltered housing apartment blockYesnoAre there vulnerable residents on siteYesNoTypes of VulnerabilitiespresentElderly residenceMobility IssuesSensory impairments ie blind, deaf, hard of hearingcognitive conditions, ie dementia, learning disabilitiesmental health concerns eg anxiety PTSDlanguage barriersotherAre any specific precautions needed when attendingResident may take longer to answer the doorAvoid certain times eg medical visitsNo loud noises or sudden movements (for anxiety or sensory issuesAdditional NotesConsent - By submitting this form, I confirm that the information provided is accurte and relevant for ensuring a safe, respectful service. Any details about a customer’s vulnerability will only be recorded or shared with their consent. I confirm that I have the authority to provide this informationI confirm that I have obtained the resident’s permission (where applicable) to share this information.Submit
