Howard County Service Record Team Member NameDate of Contact MM slash DD slash YYYY AuthorityLocationService(s) ProvidedCheck all that apply One on One Defusing Debriefing Demobilization Referral Crisis Management Briefing Other CommentsNature of EventTime SpentList Other Team Member(s) Add RemoveTap ⊕ to add addt'l rowsFollow Up Date Month Day Year Other Comments* This form must be submitted to your team leader for all Peer Support services within seven (7) days of the service date *
