Minor modifications to the Gilmore Avenue, Wellard Road, Henley Boulevard Roundabout

Works commence Tuesday 26^th September 2023 and are expected to continue for four weeks. Single lane closures will be in effect weekdays from 7.00am – 5.00pm. Some minor delays may be experienced. We apologise for any inconvenience. For more infomration visit www.kwinana.wa.gov.au/henley-boulevard-roundabout

Homelessness Support/Assertive Outreach Referral Form

Please complete the following form with as much detail as you can to help us process your request in a timely manner. This form is only to be used for non-urgent requests. For any urgent or dangerous issues, please call the City of Kwinana on (08) 9439 0200 or email kwinanaoutreach@stpats.com.au.

Please note that we take your privacy seriously and will not disclose your details to any third party without prior permission.

Referee

Name

Contact Phone Number

Email

Who is making the report?

Referral

Name of Individual (if known)

Gender

Age (approximate if unknown)

Any descriptive features our team should be aware of?

Are any children present?

If yes, Approximate age (of any children present)

In attending this referral is there anything staff should be aware of or are there any safety concerns?

Descriptions of any personal belongings of the individual

Environment

Have you seen this individual on multiple occasions?

If yes, how often?

Receptive to support

Location

Location Address

Location Description

How long at this location? If known

Any dangerous items or items of concern?

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