Howard County Service Record Team Member Name Date of Contact MM slash DD slash YYYY Authority Location Service(s) ProvidedCheck all that apply One on One Defusing Debriefing Demobilization Referral Crisis Management Briefing Other CommentsNature of Event Time Spent List 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 *
