BAS-Net > Shelter Count Forms

Monthly Data Collection

*To be completed the last Wednesday of each Month

Note: Outreach Workers/Teams are asked to fill out the Outreach Count Form

All Fields Required

Your Name

Your Email

Date

Agency Name

Program

1. Number of clients in residence on last Wednesday of the month:

2. Number of people turned away in month (total):

3. Total number of clients served in month (de-duplicated):

4. On last Wednesday of the month, were you operating at full capacity?

Capacity:

Calculate your capacity (divide clients served by total available slots and convert decimal to percentage) and report the percentage.