M-T1-CP-16-SD-02 — Community Contact Sheet

Release control

Adaptation note

Use only for the Scoped Information and Referral Desk restricted overlay under the Pop-Up Rotary Activation System. Publish the desk’s scope and explain that it is an information/referral point, not a confidential professional advisory or case-management service. Capture a topic category and concise requested outcome; collect name/contact only when follow-up is requested. Obtain explicit agreement before an identified referral and transfer only the approved minimum facts.

Instructions

1. Approve the desk scope, service-boundary script, emergency route, specialist/safeguarding handoff and referral directory before opening.
2. Offer anonymous information wherever follow-up is unnecessary. Keep anonymous tally counts separate from identifiable records.
3. Use categories and a concise requested action; stop and redirect if a person begins disclosing unnecessary sensitive detail.
4. Do not collect detailed health, family violence, financial, immigration, legal, housing-crisis, criminal-history or safeguarding narratives; identity documents; evidence images; or information about another person.
5. If immediate danger is disclosed, use the approved emergency process. Transfer safeguarding/specialist concerns through the authorised restricted route, leaving only minimal transfer facts in F05.
6. Verify the receiving person/service, explain the handoff, obtain agreement and record acceptance before marking a referral complete.
7. Close the F05 record when information is supplied or referral ownership is accepted. Do not operate an informal case file.

Controlled configuration fields

Controlled public fields

Configured community contact sheet

{{DESK_NAME}}

Supporting-document code: M-T1-CP-16-SD-02 Referral directory: {{REFERRAL_DIRECTORY_VERSION}} Collection notice: {{NOTICE_VERSION}}

What this desk can and cannot do

{{APPROVED_SCOPE}}

{{OUT_OF_SCOPE}}

This is an information and referral point. It is not a confidential professional advisory, emergency-response or case-management service. If immediate danger is disclosed, the team follows {{EMERGENCY_ROUTE}}.

Your request

Choose the closest topic: {{TOPIC_CATEGORIES}}

What outcome would be useful today? __________________________________________________________________

Please state the information, contact or referral you want. Do not include detailed medical, legal, financial, family, immigration, safeguarding or incident information on this sheet.

Follow-up, only if requested

Preferred name: ______________________________________________

Choose one contact route:

• [ ] Email: ______________________________________________
• [ ] Mobile/SMS: _________________________________________
• [ ] Telephone call: ______________________________________
• [ ] No follow-up; information today is enough

Best contact time or communication/access arrangement, if needed: __________________________________________________________________

Referral choice, only when an identified handoff is proposed

Proposed receiving service/person: ______________________________ Purpose of referral: ____________________________________________ Minimum fields to be transferred: _______________________________

• [ ] I agree that the listed minimum information may be sent to the identified recipient for the stated purpose.
• [ ] I do not agree; please provide any available public contact information instead.

How we will use your information

{{ACCOUNTABLE_ENTITY}} will use the information you choose to provide to answer this request or complete the referral you agree to. Privacy information is at {{PRIVACY_URL}}. To correct information, withdraw an uncompleted referral or raise a concern, contact {{PRIVACY_CONTACT}}.

Acknowledgement: I have read or had explained this notice. Participant confirmation: ______________________________ Date: ______________________________

Internal routing and referral record

For a specialist/safeguarding transfer, record only the transfer identifier, authorised owner, time and acceptance in this table. Use {{SPECIALIST_HANDOFF_ROUTE}} for restricted details.

Boundary, referral and release checklist

• [ ] CP-16 is treated as the restricted Scoped Information and Referral Desk overlay under CP-14.
• [ ] Approved scope, exclusions and service-boundary script are visible to visitors and briefed to staff.
• [ ] Immediate-danger, safeguarding and specialist routes are current, tested and role-owned.
• [ ] Topic categories and requested-action prompts prevent open sensitive case narratives.
• [ ] Anonymous tally and identifiable follow-up records are separate.
• [ ] Referral directory version, recipient verification and review dates are current.
• [ ] Referral consent names the recipient/category, purpose and minimum fields; acceptance is recorded.
• [ ] No identity documents, evidence images, third-party details or specialist narratives enter F05.
• [ ] Digital, private paper and assisted routes show the same notice and boundaries.
• [ ] Ordinary follow-up, overdue escalation, correction/withdrawal and closure work end to end.
• [ ] {{RETENTION_TRIGGER}} closes records after information is supplied or referral ownership is accepted.
• [ ] Staff understand that F05 is not an ongoing case-management system.

Review record