Park Hills, MO 63601
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Forms, Forms, Forms!
Unless you walk into the middle of "The Exorcist" only it's for real you are going to have to CYA. In an urgent situation you wouldn't have time to think about things like "am I going to be able to use this evidence?"... obviously. Any other time, though; do the paper work. My opinion is that it can be worth it.
Like everything else I share with you, you should use my "ametuer" efforts as a base. These are bare boned and are re-written to personalize the specifics as needed. Take what you need, make adjustments and if you improve on them please share them with me and I will update the blog with the improved form. These are offered in an effort to share what I have have learned. They are not in any way intended to be a definative work but more a collaspable skeleten upon which you can build what works for you.
Name:
Home Address:
City: State: Zip:
Home Phone:
Cell Phone:
Email Address:
In the event of an Emergency, please list the names and telephone numbers of two individuals you would like us to contact.
Emergency Contact #1
Name:
Phone:
Emergency Contact #2
Name:
Phone:
Do you give us permission to transport you to the nearest emergency medical facility should you incur serious injury or illness during an investigation? Yes No
If yes, please indicate the contact information of a physician or health care provider you would like us to contact.
Name: Phone:
Heath Insurance carrier?
Are you allergic to anything?
Do you have any pre-existing conditions about which emergency medical staff would need to know before treating you?
Are you on any prescription medications that emergency medical care providers would need to know about?
Contacts?
Hearing implement?
You are responsible for informing your lead investigator of any medical conditions that may need emergency treatment. Medical information is confidential; it is your decision and responsibility to inform other if you believe it is necessary for your health and safety while working with Haunted Missouri Paranormal Studies.
Dated and signed this ______ day of _________________, 200_.
Employee Signature
IMPORTANT: THIS INFORMATION SHOULD BE STORED IN THE EMPLOYEES PERSONNEL FILE. SUPERVISORS OF EMPLOYEES THAT WORK IN THE FIELD SHOULD HAVE IMMEDIATE ACCESS TO THIS INFORMATION.TO BE COMPLETED BY EVERY EMPLOYEE AND KEPT CURRENT
Name:
Home Address:
City: State: Zip:
Home Phone:
Cell Phone:
Email Address:
In the event of an Emergency, please list the names and telephone numbers of two individuals you would like us to contact.
Emergency Contact #1
Name:
Phone:
Emergency Contact #2
Name:
Phone:
Do you give us permission to transport you to the nearest emergency medical facility should you incur serious injury or illness during an investigation? Yes No
If yes, please indicate the contact information of a physician or health care provider you would like us to contact.
Name: Phone:
Heath Insurance carrier?
Are you allergic to anything?
Do you have any pre-existing conditions about which emergency medical staff would need to know before treating you?
Are you on any prescription medications that emergency medical care providers would need to know about?
Contacts?
Hearing implement?
You are responsible for informing your lead investigator of any medical conditions that may need emergency treatment. Medical information is confidential; it is your decision and responsibility to inform other if you believe it is necessary for your health and safety while working with Haunted Missouri Paranormal Studies.
Dated and signed this ______ day of _________________, 200_.
Employee Signature
IMPORTANT: THIS INFORMATION SHOULD BE STORED IN THE EMPLOYEES PERSONNEL FILE. SUPERVISORS OF EMPLOYEES THAT WORK IN THE FIELD SHOULD HAVE IMMEDIATE ACCESS TO THIS INFORMATION.TO BE COMPLETED BY EVERY EMPLOYEE AND KEPT CURRENT
Haunted Missouri Paranormal Studies is not responsible for accident or injury incurred while on an investigation with Haunted Missouri Paranormal Studies as a team member, guest or observer.
I, the undersigned, proceed at my own risk and take full responsibility for decisions pertaining to my own safety, health and welfare waiving financial responsibility for accident or injury which might occur during the investigation.
Signed
Witnessed
Date
Haunted Missouri Paranormal Studies agrees to waive responsibility for any accident or injury occurred while on site during an investigation. HMPS members, guests or observers do so at their own risk.
Location:
Signed:
Witnessed:
Date:
Eye Witness Questions: You may ask these questions verbally or revise the sheet and print a set to be given to them to fill out.
Name
Address
City, State
Date:
Haunted Missouri Paranormal Studies has been given permission to hold a paranormal investigation that includes the setting up, monitoring and recording of information from non invasive data collection means such as audio, video, still photographs, drawings, renderings and writings taken on sight.
Special Instructions:
Specific Limitations:
I do/do not give permission for evidence collected during this investigation to be used on the current or future website of HMPS, in compilations or anthologies written about this case. Please stipulate your privacy wishes. These may be changed at any time in writing.
Full names may be used/do not use my real name
The location may be disclosed/location will not be disclosed
Generalized information may be used/specific information may be used
Sign:
Witness:
As a member, guest or observer investigating with Haunted Missouri Paranormal Studies I agree to use my own equipment (when applicable) to take readings and gather pictorial, audio or video evidence. Original work (photograph, audio or video) taken on this investigation will be copy right of the original owner and Haunted Missouri Paranormal Studies.
This joint copy right will preserve HMPS right to copy, post or publish the work as part of investigation reports, data collections, compilations or anthologies (with full credit given) made in the future and based on this investigation. Neither the originator of this work nor HMPS will have to gain further permission from the other in order to post or publish this evidence.
Investigator: print name and sign:
HMPS representative print name and sign:
Witness:
Date:
The following personal information is to be considered confidential. It will not be published or reproduced in any way without previous permission and/or consent.
Please answer the following questions completely and honestly. This information will be used in our research and/or investigations. Names and locations will be altered on the final report unless we receive permission and/or consent. If more room is needed, please use the reverse side of the page and or attach a separate sheet of paper. Thank you for your time and effort.
Please print all answers.
Name:
Address:
Phone:
Date of Birth:
Email:
Website:
Location of activity (If different from above):
List household members:
Name_________________________________________Age_________________relationship______________________________________
Haunt activity takes many forms. Please check the kinds of experiences you (personally) have had at this location.
o Sightings: What have you seen?
o Full figure apparition, transparent
o Full figure apparition, solid
o Partial apparition, solid or vaporous --What did you see? (ex: head, torso, legs, etc)___________________________
o Shadow, fleeting (as in from the corner of the eye)
o Shadow, fully formed or partial
o Lights
o Orbs
o Glowing anomalies
o Other:
Audio: What have you heard?
o Voices, audible
o Voices, inaudible
o Your name
o Singing or music
o Distant sounds like a radio or tv
o Animal noises like barks, purrs, chirps birds singing
o Growling
o Crying
o Screaming
o Moaning
o other
Olfactory: what have you smelled that can not be accounted for naturally?
o Flowers
o Cooking smells (baking, coffee, etc)
o Cleaning supplies (pine sol, Lysol, etc)
o Perfume or cologne (hair spray, lotion, baby powder et all)
o Body odor
o Offal (Manure/poop)
o Cigarettes or cigars
o Sulfur
o Other
Have you been touched by something/someone you can't see?
Have you seemed to accidentally touch something or some one and there been no one there?
Have inanimate objects moved, been found in weird places after they disappear from ordinary places? Or found right where you left them only after a extended period of time or an exhaustive search?
Are there physical anomalies such as?
o lights flickering, light switches being turned off/on,
o Floating lights (or other anomalous lighting effects)
o windows/doors being opened/closed or locked/unlocked,
o cabinet's, drawers or closets that open/close,
o toys or electrical appliances that operate without physical interaction
Are there other witnesses to any of these events?
If so; would you be willing to ask them to fill out an interview sheet for their experiences or have them contact Haunted Missouri Paranormal Studies so we can ask them?
Do you know any history of the reportedly haunted location such as former owners, etc?
Have you experienced any of the following?
o Sleep disturbances
o Sensed presence
o Depression and/or aggression or other emotion
o Tactile sensations
o Erratic functioning of equipment
o Cold spots
o Strange responses by pets or animals
Referral source: (How did they hear about our services?)
_____________________________________________________________________
Occupation ___________________________________________________________
Interests, hobbies______________________________________________________________
Pets________________________________________________________________
How long at this address? _______________________________________________
Education level ________________________________________________________
WITNESS STATEMENTS:
Please give a general description of the occurrences. What happened?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
When did this happen? _____________________________________________________
Where exactly did you experience the disturbance? ______________________________ ________________________________________________________________________________________________________________________________________________
What was the distance between you and the disturbance? __________________________ ________________________________________________________________________
Who witnessed the events? _________________________________________________
________________________________________________________________________
Are there any stressors in the family, such as depression, mental illness, moving, loss of job, major illnesses, etc.? ___________________________________________________ ________________________________________________________________________
Is anyone under the care of a psychologist, psychiatrist, doctor, or counselor for mental illness or other disease? ________________________________________________________________________________________________________________________________________________
Do you or anyone in the family think or believe they are “psychic” or have had similar experiences? _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Belief system(s) of the household ____________________________________________
_______________________________________________________________________
_______________________________________________________________________
What do you want to have happen? Do you want referral to a minister, priest, or other person that could perform a “ceremonial cleansing?” _____________________________
________________________________________________________________________
________________________________________________________________________
Medications: ____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Health conditions: ________________________________________________________
________________________________________________________________________
List any major surgeries, major illnesses, head injuries, or neurological problems (give dates).__________________________________________________________________ _______________________________________________________________________
_______________________________________________________________________
What time do the experiences take place? ______________________________________
________________________________________________________________________
Has there been an increase or decrease in frequency or severity of the experiences?
________________________________________________________________________
What do you feel when these occur? (Fascination, fear, dread, curiosity...) ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have previous owners noticed anything, or told you about it? ______________________
________________________________________________________________________
________________________________________________________________________
Who has experienced the disturbances? Others outside the family? Friends? Relatives? ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is the activity the same or different each time? ________________________________________________________________________
________________________________________________________________________________________________________________________________________________
What do you think about what is going on? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Are there any ways to use ordinary explanations for the phenomena? ________________________________________________________________________________________________________________________________________________________________________________________________________________________
Visual phenomena
What did you see? _________________________________________________
Did it appear gradually or suddenly? __________________________________
Did it disappear gradually or suddenly? _______________________________
Was it solid or transparent? _________________________________________
Did you recognize the appearance, voice, or behavior of the phenomena?
_________________________________________________________________
_________________________________________________________________
Auditory
What did you hear? (Voices, coughing, footsteps, creaking, what?) ______________________________________________________________________________________________________________________________________________
ٱSmell
What did you smell? ______________________________________________________________________________________________________________________
Sensed presence
What did you experience? Cold? ____ Hot? ____ Like you were not alone? Tingling sensation?_______________________________________________________________
Object movement
What object______________________________________________
_____________________________________________________________________
How far? _____________________________________________________________
Did you actually see it move, or notice it later? ______________________________
______________________________________________________________________
Erratic functioning of electrical or mechanical equipment
What malfunctioned or did not work correctly? _________________________________________________________________________________________________________________________________________________________________________
What was your state of mind when you experienced it? (Going to
sleep, reading, routine, waking up?) _________________________________________
______________________________________________________________________
______________________________________________________________________
Has anyone reported sleep disturbances, problems during sleep, or strange dreams?
(Sleep walk, epilepsy, headaches, awakening many times, other?)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have things happened when no one was in the area or room when the disturbances took place? Describe. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Has anyone in the family played with Ouija boards, or been recently interested in other “psychic” matters? (Indicate the area of interest, if any). ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you have anything to add?
_____________________________________________________________
Signed
Dated
Witnessed
Interviewer comments/observations
Was this interview recorded on audio or video? If so cross reference the sources NOW to avoid delay or misplacement.
Case Manager Worksheet
Location
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Residents
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Psycho/Social Conditions
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Investigation Worksheet (Cont.) Pg. 2
Structure
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| Furnace: (electric or gas) |
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| Plumbing: | Sewer or septic:
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| Other plumbing issues:
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| Air Quality: (mold or mildew) |
| Structural Damage: |
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| Recent Renovations: |
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Historic or Traumatic Events at this Location:
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Other:
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Investigation Worksheet (Cont.) Pg. 3
Activity Reported
| Overview of activity witnessed: |
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| Main Area of Activity: |
| Apparitions: | Appearance:
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| Attire (if full body):
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| Shadows: |
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| Noises: |
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| Feelings:
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Do you use any forms I have not shown? If so i would love to know about them. Please contact us.
Park Hills, MO 63601
admin