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Colorado's Human Trafficking Hotline Conversation Report Form

PRIMARY INFORMATION

For this form (when relevant), please utilize this exact language to describe the following: Not applicable = NA, Callers who do not want to share = Prefer not to disclose; Did not have the opportunity to ask = Unknown

What type of outreach did you receive?

Call

Text

Primary reason caller is reaching out

Secondary reason caller is reaching out

Primary type of caller/texter

Secondary type of caller/texter

Type of caller/texter (if 'Other')

First Name of caller

"Unknown" (if they don't tell you or you forget to ask) or "Not Given" (if they prefer not to share)

Last Name of caller

Name of Agency (if caller is a service provider)

Service Provider Email

City of Caller/Texter

State of Caller/Texter

County of Caller/Texter

No Caller ID

Caller/Texter Phone #

Ext.

Is it safe for us (the Hotline) to call back at this number?

Please note: just because they give permission for a call back does not guarantee they will receive one from LCHT or from Law Enforcement. You CAN always guarantee a caller that Staff will review the call notes.

Call-back name

When we call back how should we identify ourselves?

Ok to leave a voicemail?

When we call back is it ok to leave a voicemail?

Call-back timeframe

Is there a specific timeframe the caller would prefer us to call back?

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Call/Text Information

Main reason for the call (Why did the person reach out today and what assistance are they hoping for?)

Main action(s) taken for this call (Explain resources provided and why you chose the resources you did. Explain what you helped someone work through.)

Action plan / Resolution (Please describe how the call ended )

Hint: To combat ambivalence, use motivational interviewing to help caller commit to an action. For example you can ask: do you think you can make those calls today? tomorrow?

Because you indicated that this is a tip call, please include all details that will help law enforcement begin an investigation.

Who is reporting this tip?

Does the reporting party give consent to be contacted by law enforcement?

Reporting party's proximity to situation

Trafficking type

SexLaborBothUnknownN/A (call not related to specific trafficking situation)

What Industry?

AgricultureRanchingConstructionDomestic ServitudeHospitalityOther

Hospitality Industry Subgroup?

RestaurantsHotelsSki IndustryCleaning ServicesMassage ParloursNail Salons

Other Industry

Who are the people involved (please be clear about perpetrator vs. victim info and include: contact information, descriptive features, social media usernames, etc.)

What happened that needs to be reported? (Please only include relevant details of the situation.)

When did this incident occur? Is it ongoing?

Where did this incident occur? Please include addresses and detailed descriptions of locations involved.

Counties where reported incident(s) occurred

Please describe why the caller believes this is a trafficking situation. If unclear, gently ask the caller to help you understand the connection to trafficking.

Caller Needs

Basic Needs Assistance (food, clothing, financial)	Case Management
Companionship/Counseling	General Hotline or HT Information
Law Enforcement	Legal Assistance
Medical Services	Mental Health Services
Outreach/Printed Materials	Shelter
Training	Translation Services
Transportation	Other
NA

Other Caller Needs

NOTE: Please only select "Other" if what the caller requests is not on the list. Don't forget that General Hotline or HT Information is there for Informational calls, Companionship/Counseling is there for mental health calls, and Law Enforcement is there for tip calls! Thank you!

Referrals provided

COVA	CLS
Cultural Development and Wellness Center	ALIGHT
Colorado Coalition for the Homeless	Gathering Place
Voluntad	Blue Bench
RMIAN	National Human Trafficking Hotline
TESSA	Crime Victim Compensation
Other	Not Applicable

Other Referrals provided

Was a warm handoff facilitated?

'Other' Warm Hand-off

Has this been reported to the Child Abuse & Neglect Hotline? (Mandatory Reporting)

YesNo

Mandatory Report Case #

Other Mandatory Reporting?

YesNo

To whom?

Case #

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Age of caller not provided

Age of caller

Gender identity of caller

Male	Female
Trans woman	Trans man
Gender expansive	Multiple (more than one caller)
Unknown	Prefers not to answer
Other

Caller race/ethnicity

Please use CTRL + Click OR Command + Click to select all that apply

Special Classification of Caller

Deaf/Hard of Hearing	Homeless
Immigrant/Refugee/Asylum Seeker	LGBTQ+
Veteran	Disability: (cognitive, physical, or mental)
Limited English Proficiency	Other
N/A - no special classification

If asking this question (rather than filling it in from context clues) please use gentle language: "Do you identify as..."

Is the caller / texter reaching out about someone besides themself?

Yes, they are reaching out about someone elseNo, they are reaching out for themself

Survivor ID Section (when reported by 3rd party who is NOT the survivor)

State of Client / Survivor (if not caller/texter)

County of Client / Survivor

City of Client / Survivor (if not caller/texter)

Survivor gender

MaleFemaleTrans womanTrans manGender expansiveMultiple (more than one)UnknownPrefers not to answerOther

Survivor national origin

DomesticForeignBothUnknown

Survivor age

AdultMinorBothUnknown

Survivor race/ethnicity

Please use CTRL + Click OR Command + Click to select all that apply

Special Classification of Survivor

Deaf/Hard of Hearing	Homeless
Immigrant/Refugee/Asylum Seeker	LGBTQ+
Veteran	Disability: (cognitive, physical, or mental)
Limited English Proficiency	Other
N/A - no special classification

If asking this question (rather than filling it in from context clues) please use gentle language: "Do you identify as..."

Do you have any information about the perpetrator to share?

YesNo

Perpetrator Information

Perp age

AdultMinorBothUnknown

Perpetrator national origin

DomesticForeignBothUnknown

Perp gender

MaleFemaleTransgenderNon-binary / third genderGender fluidGender queerMultiple (more than one)UnknownPrefers not to answer

Perp race/ethnicity

Please use CTRL + Click OR Command + Click to select all that apply

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Data to be collected

Advocate First Name

Advocate Last Name

Date of Call/Text

Number of Calls or Text Conversations (with this caller)

For texters, this is the number of conversations you had with an individual, not the number of text messages exchanged. Most text conversations = 1. If you select more than one, please use "Add another response" below to document the start and end time of all calls / distinct text conversations.

Start Time of Call/Text(1)

Please include AM or PM

End Time of Call/Text(1)

Start Time of Call/Text (2)

Please include AM or PM

End Time of Call/Text (2)

Start Time of Call/Text (3)

Please include AM or PM

End Time of Call/Text (3)

Start Time of Call/Text (4)

Please include AM or PM

End Time of Call/Text (4)

Start Time of Call/Text (5)

Please include AM or PM

End Time of Call/Text (5)

Start Time of Call/Text (6)

Please include AM or PM

End Time of Call/Text (6)

Start Time of Call/Text (7)

Please include AM or PM

End Time of Call/Text (7)

Start Time of Call/Text (8)

Please include AM or PM

End Time of Call/Text (8)

Start Time of Call/Text (9)

Please include AM or PM

End Time of Call/Text (9)

Start Time of Call/Text (10)

Please include AM or PM

End Time of Call/Text (10)

Total Length of Time of Call/Text (1)?

If other, please describe.

Additional Calls / Texts

What is the total length of all other calls / texts (in minutes)

Example: 20 minutes

Who Initiated Call?

Did you contact backup?

YesNoCheck yes only if you contacted Backup to report a tip or ask a question/seek support. Not relevant for each time you notify them of a call received.

Why was Backup contacted?

Backup contacted

What language was spoken on the call / text?

If 'Other', what language was used?

Was the language line used?

YesNo

Did someone previously call/text about this case?

YesNoUnknown

If repeat caller/texter, why are they calling back?

How did caller find out about the hotline/textline?

'Other' how they heard about the hotline

If unknown, why?

Advocate did not have the opportunity to ask or forgot toCaller could not recall how they found out about the hotline

What type of advertisement?

What specific social media outlet?

What specific news outlet?

This was a challenging call/text and I would like follow up from a Backup Manager or Staff

Yes

Thank you for filling out your Conversation Report Form!