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Peer Support Activity Summary

Please report all conversations in which any employee expressed a personal or professional problem in a way which made it appropriate for you to listen and respond using methods learned in peer support training. The counseling you report need not have been specifically requested as “peer support counseling” or “counseling”. If a referral was made, please note where the referral was made (i.e., Psych Professional, Chaplain, Employee Assistance Program, AA, etc)
Name
Assignment
Topic(s)
- ALCOHOL
- CAREER
- CHILDREN
- DEATH/DYING/BEREAVEMENT
- DEPRESSION
- DISCIPLINARY
- DISABILITY INJURY
- HARASSMENT
- FINANCIAL
- GRIEVANCE
- JOB INCIDENT
- MEDICAL/HEALTH/ILLNESS
- POST TRAUMATIC STRESS
- PROMOTIONAL PROCESS
- RELATIONSHIP
- RETIREMENT
- SUBSTANCE ABUSE
- SUICIDE
- SUPERVISOR/SUPERVISEE
- OTHER
ALCOHOL
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
CAREER
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
CHILDREN
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
DEATH/DYING/BEREAVEMENT
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
DEPRESSION
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
DISCIPLINARY
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
DISABILITY INJURY
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
HARASSMENT
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
FINANCIAL
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
GRIEVANCE
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
JOB INCIDENT
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
MEDICAL/HEALTH/ILLNESS
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
POST TRAUMATIC STRESS
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
PROMOTIONAL PROCESS
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
RELATIONSHIP
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
RETIREMENT
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
SUBSTANCE ABUSE
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
SUICIDE
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
SUPERVISOR/SUPERVISEE
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
OTHER
NUMBER OF CONTACTS
TIME SPENT
(1/4, 1/2, 1HR)
REFERRALS MADE
(I.e., PSYCH PRO, UBH, ETC.)
Total # of Contact(s)

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ALCOHOL

CAREER

CHILDREN

DEATH/DYING/BEREAVEMENT

DEPRESSION

DISCIPLINARY

DISABILITY INJURY

HARASSMENT

FINANCIAL

GRIEVANCE

JOB INCIDENT

MEDICAL/HEALTH/ILLNESS

POST TRAUMATIC STRESS

PROMOTIONAL PROCESS

RELATIONSHIP

RETIREMENT

SUBSTANCE ABUSE

SUICIDE

SUPERVISOR/SUPERVISEE

OTHER