Fillable LOST PERSON QUESTIONNAIRE A. SOURCE(S) OF INFORMATION FOR (Utah County Government)

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LOST PERSON QUESTIONNAIRE A. SOURCE(S) OF INFORMATION FOR (Utah County Government)

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File type: PDF

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YN YN
Comments:
Overall Appearance:
Photo Available:
Style/Color:
C. PHYSICAL DESCRIPTION
Interviewer(s):
Cell Phone Carrier: E-mail Address:
Where/How to contact now:
Where/How to contact later:
What does informant believe happened:
DOB:
Incident Title:
Location:
A. SOURCE(S) OF INFORMATION FOR QUESTIONAIRE
Time:Today's date:
B. LOST PERSON
Incident Number:
LOST PERSON QUESTIONNAIRE
NOTE: Use pencil/black ink, print clearly. Avoid confusing phrases/words and unfamiliar abbreviations.
Complete and detail answers for future use. Answer ALL questions, if possible.
Style/Color: Mustache:
Where:
Fake nails:
Beard:
Color of fingernails:
Name: How Info Taken:
Home Address:
Home Phone: Cell Phone: Relationship:
Local Address:
Height: Weight: Age: Eye Color:Build:
Sex:
Maiden Name:
Full Name:
Nicknames: Other AKA's:
Home Address: Zip:
Zip:
Home Phone: Local Phone: Cell Phone:
Birthplace: Ethnicity: National Origin: Language:
Hair: Current Color: Natural Color: Length: Style/Binding/Wig:
Color of fingernails:
Sideburn:
Distinguishing marks (scars/moles/tattoos/piercing):
Jewelry (and where worn, incl. medical bracelets):
Eyewear/Contacts (sunglasses, spares):
Photo Returned:
Facial Features Shape: Skin Color: Tone: Complexion:
Page 1 of 9
YN
YN
YN
YN
YN YN
D. TRIP PLANS OF SUBJECT
Alone: Group size:
Done trip before: Details:
Day/Date: Time:Started from:
Transported by whom/means:
Vehicle now located at: Type: Color:
Additional names, cars, licenses, etc. for party:
Alternate plans/routes/objectives discussed:
Return time: From where:
By whom/what:
License #: State: Verified: By whom:
Shirt sweater:
Pants: (belt/suspenders)
Outerwear:
Under wear/socks:
Discussed with whom: When:
Comments:
E. CLOTHING
ITEMS STYLE COLOR SIZE OTHER
Sole type:
Head wear:
Rain wear:
Glasses:
Gloves:
What:
Foot wear:
Neck wear: (scarf/tie)
Extra clothing:
Secured:
Where:
Scent articles available:
Sample available:
Where is scent article now:
Overall coloration as seen from air:
Going to: Via:
Purpose:
For how long: Exit date:
Page 2 of 9
YN
YN
YN
YN
Comments:
Familiar with area: How recent: Other:
Subject complaining of anything:
Subject seem tired: Cold/Hot: Other:
Seen going which way: When:
Reason for leaving:
Attitude (confident, confused, etc.):
Where: Subject matter:
Weather at time: Weather since:
Time: Where: On foot/other:
Seen by whom:
Who last talked at length with person:
F. LAST SEEN
G. OUTDOOR EXPERIENCE
Where:
Other areas of travel:
When:
How much: Scout rank: Scout Leader:
When:Scouting experience:
Medical training:
Military Experience:
How fast does subject hike:
Comments:
Where:When:What:
When:
Where:Ever go out alone:
Rank: Other:
Generalized previous experience:
How much overnight experience:
Stay on trail or cross country:
Ever lost before: Where:
Risk taker:
Athletic/other interests:
Climbing experience:
Where:
When:
Formal outdoor training / degree:
Page 3 of 9
YN
Y N
YN
YN
YN
Dentist: Phone:
Comments:
Medication:
Dosages:
What will happen without meds:
Dentures/partials:
I. HEALTH / GENERAL CONDTION
Overall health:
Known medical/dental problems:
Phone:
Handicaps/deformities/prosthetics:
Known psychological problems:
Knowledgeable doctor:
Overall physical condition:
Personal problems:
Religious: Faith: To what degree:
Personal values:
Local/fictional hero:
Comments:
Education (highest grade achieved): Current status:
What: Brand:How often:
Other:
Smoke? How often: What: Brand:
Hitchhike?
H. HABITS / PERSONALITY
Recreational drugs? What:
Gum brand: Candy Brand:
Give up easy / Keep going:
Gregarious / loner:
Alcohol?
Accepts rides easily:
Evidence of leadership:
Hobbies/Interests:
Outgoing / quiet:
Philosophy:
Person closest to: In family:
Emotional history:
College education:
School name:
Teachers:
Subject/Degree:
Legal trouble (past / present):
Page 4 of 9
YN
Y N
J. PERSONAL ITEMS / EQUIPMENT
SIZE
Pack:
EQUIPMENT STYLE COLOR BRAND
Ground Cloth/Pad:
Sleeping bag:
Tent:
Camera:
Knife:
Stove: Fuel: Starter: What:
Breed:
Holster:
Age:
Color:
Dog/dogs:
Dogs name:
Other documents:
Size: Color: Sex:
Barking/habits:Aggressive:
Collar: Color:
Bindings:
Drinking liquid container: Liquid amount: What kind:
Of where:Map:Compass:
Light:
Climbing Equipment:
Fishing Equipment:
How competent with map/compass:
Food:
Brands:
Skis: Type: Brand:
Bindings:
How competent:
Length:Pole type:
Size:
Color: Size:
How competent:
Firearms: Brand: Model:
Snowshoes: Type: Brand: Color:
Money: Amount: Credit/debit cards:
Lead:
Comments:
Page 5 of 9
YN YN
EQUIPMENT BRAND MODEL COLOR FREQUENCY
GPS
PLB/EPIRB
Wireless Device
IPOD/MP3
Headphone/Earbuds
Laptop
Thumb drive
Handheld radio
Afraid of dark: Animals: Afraid of:
Relationship:
Zip:
M. CHILDREN
Address: Zip:
Anyone home now:Phone #:
Full name:
Address:
Relationship:
Zip:
Phone #: Anyone home now:
Active/lethargic/antisocial:
Comments:
Training when lost:
Strangers:Feelings toward adults:
Reactions when hurt: Cry:
Full name:
Full name:
Address:
Phone #: Anyone home now:
Relationship:
L. UPON REACHING CIVILIZATION WHO WOULD THEY CONTACT
K. ELECTRONIC EQUIPMENT
Wireless Device
Page 6 of 9
Leader:
Experience of group leader:
N. GROUPS OVERDUE
Intergroup dynamics:
Comments:
Address/Phone of knowledgeable person:
Personality clashes within group:
Leader types in group other than leader:
What would subject do if separated from group:
Name/kind of group:
O. ACTIONS TAKEN SO FAR
By: Family/Friends:
Competitive spirit of group:
Results:
Others:
Results:
Comments:
P. PRESS/FAMILY RELATIONS
Nest of kin: Relationship:
Zip:Address:
Phone #:
Significant family problems:
Family's desire to employ special assistance:
Occupation:
What haven't I asked you:
Comments:
Q. OTHER INFORMATION
Comments:
Page 7 of 9
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
OTHER
LINKEDIN
OTHER
USERNAME PASSWORD
TWITTER
MYSPACE
PINTEREST
R. SOCIAL NETWORKING
USERNAME PASSWORD
FACEBOOK
INSTAGRAM
FIND MY PHONE
FIND MY FRIENDS
Page 8 of 9
YN
Y N
INITIAL LOST PERSON QUESTIONNAIRE:
NOTE: Use pencil/black ink, print clearly. Avoid confusing phrases/words and unfamiliar abbreviations.
Complete and detail answers for future use. Answer ALL questions, if possible.
Incident Title: Today's date: Time:
Nicknames:
Interviewer(s): Incident Number:
Location:
Full Name: Sex:
Cell Phone Carrier:
Cell Phone:Local Address:
Height: Weight: Age: Hair: Current Color: Length:
Time: Where: On foot/other:
Seen going which way:
Beard: Mustache: Overall Appearance:
Overall coloration as seen from air:
Results:
LOST PERSON:
PHYSICAL DESCRIPTION:
LAST SEEN:
OUTDOOR EXPERIENCE:
HEALTH / GENERAL CONDTION:
PERSONAL ITEMS / EQUIPMENT:
Firearms: Brand: Model:
ACTIONS TAKEN SO FAR:
By: Family/Friends:
Familiar with area: Stay on trail or cross country:
Overall health:
Handicaps/deformities/prosthetics:
Known psychological problems:
Page 9 of 9
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LOST PERSON QUESTIONNAIRE A. SOURCE(S) OF INFORMATION FOR (Utah County Government)

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Completed 6 August 2020

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