Address Contact Details Client’s Type of Dwelling Freeholder Yes/No Tenant Name & Address of – Landlord Name Relationship DOB Household Members Pets Indicate what – pets and any concerns Agencies Currently Involved Non-Agency Support Currently in Place Attitude Toward Client’s Hoarding Please Indicate if Present at the Property Structural Insect or Large number Clutter Damage to Rodent of Animals Outside Property Infestation Concerns over Animal Waste Visible Human Rotten Food the Cleanliness in House Faeces of the Property Concerned for Concerned for Concerns of the Children Other Adults at Self Neglect at the the Property property
Address Client’s Contact Details Type of Dwelling Freeholder Yes/No Tenant – Name & Address of Landlord Household Members Name Relationship DOB Pets – Indicate what pets and any concerns Agencies Currently Involved Non-Agency Support Currently in Place Client’s Attitude Toward Hoarding Please Indicate if Present at the Property Structural Damage to Property Insect or Rodent Infestation Large number of Animals Clutter Outside Rotten Food Animal Waste in House Concerns over the Cleanliness of the Property Visible Human Faeces Concerns of Self Neglect Concerned for the Children at the property Concerned for Other Adults at the Property
FINAL-Self-Neglect-Guidance-North-Tyneside-and-Northumberland-07-03-16.docx