PROJECT SAFE AND SOUND

Project Safe and Sound is designed for officers to appropriately respond to an individual who is diagnosed with a mental impairment such as Autism, Schizophrenia, Dementia, etc. All information is given on a volunteer basis by the caregiver of the individual. This form will allow officers from the police, fire, EMS, and Communications departments to correctly relay information to all personnel responding to a call involving a particular incident with the individual.

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First Name

Last Name

Phone

Date of Birth

Nickname

Address

Address Line 1

Address Line 2

City

Country

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State/Province

Select

Zip Code

Gender

Male
Female

Race

Height

Weight

Hair

Eyes

Preferred Communication Method

Former Military

Fearful of EMS/Fire/Police

Does the individual have access to a vehicle?

License Plate #

Make

Model

Year

Color

Agency Needed Information

*If field is not applicable please enter "NA".

Identifying Marks/Scars/Tattoos

Medical Diagnosis/seizures?

Mental Health Triggers/Fears:

Frequented Locations

How should officers approach the individual?

Calming efforts

Interests (favorite objects, music, discussion topics, likes, or dislikes)

Contact Person

First Name

Last Name

Phone

Relationship

Select

Add

Upload Picture of the Individual

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As a caregiver to this individual, I agree to share all the listed information with Kinston Police Department, Kinston Fire Department, and Lenoir County Emergency Services. I am aware that this information is voluntary and will only be used to ensure the safety of the listed individual if contact is needed by any of the listed agencies.

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Signature

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Date