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Your Details

These details refer to the person who is submitting the referral. In case of queries relating to this referral, we will use these details to contact you.

If you are submitting a referral on behalf of yourself, you may leave this section blank.








* if you're contacting us on behalf of an organisation, please enter the name of that organisation here. Otherwise, you can leave this field blank.


Client Details

These details refer to the person that you'd like the Bobby Scheme to support.











About the Property



Please Note that where the occupant is a tenant and not the owner occupier they will need to seek consent from their landlord before the Trust can carry out work. Also be aware that we cannot change locks at a jointly owned property without both parties' consent.

Type of Referral

Please select an option to indicate how the client meets our referral criteria.

General Referrals

Is this referral urgent?


If the referral is urgent, please briefly explain why.



Please give a brief description for the reason a visit is required including any areas of particular concerns. Also please advise if there is a need for a carer/supporter/family member to be present at the time of the visit.



Please Note the Trust cannot carry out any work of an electrical nature such as lighting, CCTV or alarms, nor carry out repair work. The Trusts area of expertise is securing the main entry points of the property and any out building.

Are there any risks posed to our fitter attending alone and if so what?



Domestic Abuse Referral

Please only complete this section if the reason for referral is domestic abuse. If not, you can skip to the bottom of the form and submit.

Please give a brief description for the reason a visit is required including any areas of particular concerns. Also please advise if there is a need for a carer/supporter/family member to be present at the time of the visit.



Please Note the Trust cannot carry out any work of an electrical nature such as lighting, CCTV or alarms, nor carry out repair work. The Trusts area of expertise is securing the main entry points of the property and any out building.

Is this referral urgent?


If yes, Please indicate level of urgency



The level of urgency will be assessed using the information provided to the following questions.

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Please Note in any Domestic Abuse case the referrer is required to assess the risk to our fitter attending the property alone and indicate if support from a PC or PCSO is necessary for the visit to take place safely.

If yes, please give details



If yes, please give details



Please give the name of the police officer dealing with the case



Ensuring our fitters safety when attending alone is of paramount importance to us. Failure to provide accurate answers to any of these questions will result in us declining to attend.

Confirmation

By submitting this form, you confirm that the client has given their permission for you to pass their information to the Trust and that the client is aware that we will make contact with them.

Hampshire County Council Southampton City Council Portsmouth City Council Isle of Wight Council
Hampshire Fire and Rescue Service Hampshire Constabulary Isle of Wight Fire and Rescue Service South Central Ambulance Service