EIPP CYFS – 2 week snapshot sheet – For advice and referral only (excluding CYFS case managed clients)
Date:
Person’s responses to questions:
Did we help you find out anything new:
1. Person receiving
advice/information
2. Type of
advice/information
provided
3. Source of contact
with service
4. Approximate time
spent with person
5. About
6. To assist you as a
services/things in the parent/carer?
community for CYP/
families?
7. Has this service
been useful?
Parent/carer
About services
Parent under 21 years
About parenting
YP (12 – 17 years)
Relevant to YP for
YP (18 – 24 years)
positive life choices
Other person
Other
In person
By telephone
Email/Internet
Other
Less than 30 mins
30 mins – 2 hours
2 – 3.5 hours
3.5 – 7 hours
7 – 10 hours
More than 10 hours
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, very useful
Yes, somewhat useful
No, not useful
Rather not say
Question not asked
Parent/carer
About services
Parent under 21 years
About parenting
YP (12 – 17 years)
Relevant to YP for
YP (18 – 24 years)
positive life choices
Other person
Other
In person
By telephone
Email/Internet
Other
Less than 30 mins
30 mins – 2 hours
2 – 3.5 hours
3.5 – 7 hours
7 – 10 hours
More than 10 hours
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, very useful
Yes, somewhat useful
No, not useful
Rather not say
Question not asked
Parent/carer
About services
Parent under 21 years
About parenting
YP (12 – 17 years)
Relevant to YP for
YP (18 – 24 years)
positive life choices
Other person
Other
In person
By telephone
Email/Internet
Other
Less than 30 mins
30 mins – 2 hours
2 – 3.5 hours
3.5 – 7 hours
7 – 10 hours
More than 10 hours
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, very useful
Yes, somewhat useful
No, not useful
Rather not say
Question not asked
Parent/carer
About services
Parent under 21 years
About parenting
YP (12 – 17 years)
Relevant to YP for
YP (18 – 24 years)
positive life choices
Other person
Other
In person
By telephone
Email/Internet
Other
Less than 30 mins
30 mins – 2 hours
2 – 3.5 hours
3.5 – 7 hours
7 – 10 hours
More than 10 hours
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, very useful
Yes, somewhat useful
No, not useful
Rather not say
Question not asked
Parent/carer
About services
Parent under 21 years
About parenting
YP (12 – 17 years)
Relevant to YP for
YP (18 – 24 years)
positive life choices
Other person
Other
In person
By telephone
Email/Internet
Other
Less than 30 mins
30 mins – 2 hours
2 – 3.5 hours
3.5 – 7 hours
7 – 10 hours
More than 10 hours
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, a lot
Yes, some
No, nothing new
Rather not say
Question not asked
Yes, very useful
Yes, somewhat useful
No, not useful
Rather not say
Question not asked