Significant Conversation Report

Date and Time

Name of Support Person

Email

Name of Individual

Location

Other Individuals Involved In Conversation

Approximate Duration of Conversation

Topic of the Conversation

Describe what was happening prior to the conversation? (Event Setting)

Describe the conversation as detailed as possible; Include as many direct quotations as possible, as well as other information such as body language, movement and tones.

What were the significant turning points or highlights of the conversation?

How would you suggest approaching this topic in the future?

Is any follow up conversation required? -- Is any follow up conversation required? -- Yes No

Would you like a debriefing with your Team Leader/Coordinator/Executive Director? -- Would you like a debriefing with your Team Leader/Coordinator/Executive Director? -- Yes No

Signature