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Victoria, BC
Canada

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MISSING PERSON QUESTIONNAIRE


MISSING PERSON QUESTIONNAIRE

                                      Task/Mission Number:

CONTACT INFORMATION MISSING PERSON INFORMATION

LAST Name:

Contact's Name: FIRST Name:

Present Phone #: Nic Name:

Present Location: Age: Mental Age:

Reached for further info: Height: Weight:

(phone # if not present)

Relationship to lost person: Build: Race:

Optional: Distinguishing marks/scars:

Home address:

Home/Business phone #:

BACKGROUND PROFILE

Number of missing persons: Have they separated?:

Classification (hiker, child, etc.): If child - Password:

TIME: DATE: Grid location:

Where is the PLS/LKP?: Latitude:

Longitude:

Maps on site (Y/N)?: Scale: Map sheet #'s:

Zone #: Air photos (Y/N)?: Scale: ID #:

Is there a history of incidents in this area?:

If Yes, describe:

Has person done this before? (Y/N):

If Yes, describe:

Last seen by who?:

Contact at?: Location?:

(Enter phone # if not present)

Reason for leaving?:

Purpose of trip:

Destination: Unusual circumstances:

Via:

Alternate plans:

Planned stops:

Bastard search possible (Y/N)?:

MISSING PERSON PROFILE

Any known psychological/emotional problems? (Y/N Desc):

Any current family/personal problems? (Y/N Desc):

Any history of depression or running away? (Y/N Desc):

Will person keep moving or stay put? (Y/N Desc):

Any outdoor/survival training? (Y/N Desc):

Aliases: Describe personality:

Occupation:

Date of Birth: Likes group or solo activities:

Hair colour: Balding? (Y/N): Evidence of Leadership:

Length: Degree:

Religious?:

Mustache (Y/N): Type:

Sideburns: Style: Status at school/work:

Beard: Style:

Hitchhike?:

Complexion: Eye colour:

(Light, Medium, Dark)

Home address:

Home phone #:

Next of kin: Phone #:

Address:

CHILDREN AND GROUP PROFILE

FOR CHILDREN FOR GROUPS

Active or lethargic type: What is the experience of

Describe any fears?: the leader:

Actions taken when hurt? (cry, etc.?): Experience of rest of

group:

Talk to strangers? (Y/N):

Accept rides? (Y/N): Actions if separated:

Close friends/personality

clashes:

Any strong leaders not

actually the leader??:

MEDICAL PROFILE

Any suspected injury? (Y/N Desc): Use any aids? (Desc):

(glasses, hearing aid)

Consequence of loss?:

Any suspected illness? Allergies?:

(ex. Diabetes)? (Y/N Desc):

Any handicaps?:

On any medication? (Y/N Desc):

Physical condition:

Consequence of loss?: Nutritional state:

Have it with them? (Y/N):

How much?: Time of last food intake:

Doctor's Name: Phone #:

EXPERIENCE AND KNOWLEDGE PROFILE

Rate familiarity with the area? (V/F/N): V=very familiar

F=familiar

N=not familiar

Rate the level of experience (E/A/B): E=Experienced

A=average

B=beginner

Ever been lost before? (Y/N): If yes, is there

Describe the action taken: a file available?:

(By the lost person)

Any other areas of related experience? (Y/N): Describe:

Any overnight back-country experience? (Y/N): Describe:

Any First-aid training? (Y/N): Level: When?: Where?:

Any scouts, guides, military training? (Y/N): When?: Where?:

Any previous long trips? (Y/N) : When?: Where?:

Athletic interests/hobbies:

Any other relevant experience/knowledge? Describe:

CLOTHING AND EQUIPMENT PROFILE

Have adequate clothing to spend the night? (Y/N Desc):

Desc. outer garments (colour/style):

Have adequate equipment/supplies to spend the night? (Y/N Desc):

Have any food/snacks? (Y/N Desc):

Have any water?: Amount?:

Describe the footwear:

Sole type:

Is there a sample available? (Y/N):

Where?:

Any scent articles?:

Articles to be handled only by Dog Handler!

Describe: Where located?:

ITEM COLOUR DESCRIPTION

Hat:

Scarf:

Coat/Jacket:

Sweater:

Shirt :

Pants:

Shorts:

Socks:

Underwear:

Gloves/Mitts:

Raingear:

Extra clothing?: Describe:

Container?:

Food?: Candy?:

Describe:

Cigs?: Brand?:

Money?: Amount?:

Credit Cards?: Which ones?:

Jewellery?: Watch?: Other?:

Survival gear?: Describe:

Maps?: Map type?:

Compass?: Compass type?:

First-aid Equipment? : Describe:

Boat?: Describe:

Fishing Gear?: Type/Desc.:

Firearms?: Type :

Lic. Tags?: Desc.:

Climbing gear?: Describe:

Backpack?: Brand/Type?: Size?:

Knife?: Type?:

Flashlite?: Battery - Size & No:

Radio?: Whistle?:

Flagging tape?: Tape colour?:

Signal mirror?: Flares?: Type?: Other?:

Sleeping bag?: Brand?: Colour?:

Sunglasses?:

Stove?: Type?: Fuel with person?:

How much?:

Skis?: Type: Colour: Style:

Length: Bindings: Ski-wax:

Poles-desc.: Colour: Length:

Snow-shoes?: Type: Colour:

Drinking fluids?: What kind?: Amount:

NOTES:

TERRAIN PROFILE

Any possible hazards in the area? (Y/N Desc):

Any possible natural barriers? (Y/N Desc):

Any possible escape (ex. drainage) routes? (Y/N Desc):

Any attraction in area? (Y/N Desc):

Desc. general terrain (mountains, flats, hills):

Any confusion factors? (Y/N Desc):

Any other possible shortcuts? (Y/N Desc):

Elevation:

Desc. general flora (swampy, forest, salal):

WEATHER PROFILE

Is there any hazardous weather now? (Y/N Desc):

Within 12 hours? (Y/N Desc):

Within 48 hours? (Y/N Desc):

Describe the local weather:

Expected precipitation (24hrs):

Temp High: Cloud cover:

Temp Low: How much cover:

Kind of cover (broken, scattered, etc):

Sun rise:

Sun set: Altitude:

Moon rise: Wind Speed:

Moon set: Wind direction:

Moon phase:

VEHICLE PROFILE

Vehicle located at?: Verified? (Y/N):

Was person to be picked up? (Y/N): Pick-up time: Pick-up place:

Name of person picking-up?:

Address: Phone #:

Used a vehicle? (Y/N): Stay with vehicle? (Y/N):

Make: Model: Colour: Lic. #:

NOTES:

MISSING CHILD INFORMATION FORM - SCHOOL

Date : ________________ Time (reported missing) : _________________

Elapsed Time : _________________

Name : _________________________________ Nickname : _______________________

Password : _______________________

Parent/Guardian Name :_________________________________

Address : _____________________________________________ Phone #: ____________

LAST KNOWN LOCATION :_________________________________________________________

Age : _______ Mental Age : ________ Sex: ________ Race : __________________

Height : ____________ Weight : ________ Build : ________________________

Hair colour:____________ Hair Length : ___________ Eye colour : _____________

Wear glasses? : ____

Physical characteristics : ______________________________________ (scars etc.)

Physical condition : _________________________________________________________

Growth Problems/Allergies : __________________________________________________

Known Fears : ________________________________________________________________

Coat : ___________ Shirt : ___________ Dress :___________ Sweater : __________

Pants : __________ Skirt : ___________ Hat : ____________ Other :_____________

Boots : ________________________________ Shoes : _____________________________

Runners : ______________________________ Other : _____________________________

Lunch kit : ____________________________ Food : ______________________________

Backpack/School bag : __________________ Toys : ______________________________

School books : _________________________ Other : _____________________________

School : ________________________________________ Phone #: __________________

Home room Teacher: ______________________________ Phone #: __________________

Classroom #: __________

Known intentions : ___________________________________________________________

Areas child frequents : ______________________________________________________

Ever been lost before : ____________ Where found : ___________________________

Actions taken : ______________________________________________________________

Point last seen : ____________________________________________________________

Home to school arrangements : ________________________________________________

Transporter's Name: ______________________________ Phone #: __________________

Names of child's friends :____________________________________________________

Description, Names of companion(s), if any : _________________________________

______________________________________________________________________________

Circumstances of disappearance:

____________________________________

____________________________________

____________________________________

____________________________________ PHOTO

____________________________________

____________________________________

____________________________________

____________________________________

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Last Updated: Saturday, 09-Jun-2007 17:26:21 PDT

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