G Survey Final Format

997
2015 Philadelphia Point-in-Time Count Survey
Homeless Outreach Hotline: 215. 232.
1984
Location description:
(e.g. North side of 1200 Locust St)
Q
PIT ZONE: ________
Tens Place (00) 0
Ones Place (00) 0
Hello, my name is __________________ and I'm a volunteer with the City of Philadelphia. We are conducting a survey asking people about their
housing situation. Your participation is voluntary and you may refuse to answer any question. The survey will take a couple minutes. Can I ask you
some questions?
Yes
No (IF PERSON APPEARS HOMELESS, COUNT ON TALLY AND OFFER TO CALL OUTREACH)
Permission
Number Blank:
Number Responded:
Percentage Responded:
Number Yes:
Number No:
Percentage Yes of
Responded:
Percentage Yes of all
Surveyed:
Percentage No of
Responded:
Percentage No of all
Surveyed:
10
58
85.2
9
48
10
82.7
6
70.5
9
17.2
4
14.7
1
1. Has another volunteer already asked you about where you are staying tonight?
Yes (GO TO THANK YOU, END SURVEY)
No
Deduplication
Number Blank:
Number Responded:
Number Yes:
Number No:
7
61
89.7
1
2
59
Percentage Yes of
Responded:
Surveyed:
Percentage No of
Responded:
Surveyed:
2. Where are you sleeping tonight?

Own Room: Apartment/House/Rental Unit/Hotel
Staying with Family or Friend/Couch Surfing
Subway or Bus Station/Airport
3.28
2.94
96.7
2
86.7
6
Sidewalk/Car/Park/Abandoned Building
Hospital/VA Med Center
Dont Know/Refused
Where Staying
Number Blank:
Number Responded:
Number Own Room:
Number Outdoor/Car/Park/Abandoned Building:
Number Couch Surfing/Staying with Friend:
Number Drop in Center/Cafe:
Number Shelter:
Number DK/Ref:
Percentage Own Room of Responded:
Percentage Own Room of all Surveyed:
Percentage Outdoor/Car/Park/Abandoned Building of
Responded:
Percentage Outdoor/Car/Park/Abandoned Building of
all Surveyed:
Percentage Couch Surfing/Staying with Friend of
Responded:
Percentage Couch Surfing/Staying with Friend of all
Surveyed:
Percentage Drop in Center/Cafe of Responded:
Percentage Drop in Center/Cafe of all Surveyed:
Percentage Shelter of Responded:
Percentage Shelter of all Surveyed:
Percentage DK/Ref of Responded:
Percentage DK/Ref of all Surveyed:
0
68
100.0
0
22
1
35
1
9
20
32.35
32.35
1.47
1.47
51.47
51.47
1.47
1.47
13.24
13.24
29.41
29.41
Shelter
Drop-in Center or Caf
3. (DO NOT ASK, SURVEYOR OBSERVATION) Do you believe this individual is homeless?
Yes
No (GO TO THANK YOU AND END SURVEY, DO NOT COUNT ON TALLY)
Homeless
Number Blank:
Number Responded:
0
68
100.0
0
1
67
1.47
1.47
98.53
98.53
Number Yes:
Number No:
Percentage Yes of Responded:
Percentage Yes of those Surveyed:
Percentage No of Responded:
Percentage No of all Surveyed:
4. How old are you?
4a. If participant is unsure, prompt:

Under 18
18-24
25-59
Over 60
Age
Number Blank:
Number Responded:
Number U18:
Number 18-24:
Number 25-59:
Number DK/Ref
Percentage U18 of
Responded:
Percentage U18 of those
Surveyed:
Percentage 18-24 of
Responded:
Percentage 18-24 of all
Surveyed:
Percentage 25-59 of
Responded:
Percentage 25-59 of those
2
66
97.0
6
14
49
2
1
21.2
1
20.5
9
74.2
4
72.0
6
3.03
2.94
Dont Know/ Refused
Surveyed:
Percentage DK/Ref of
Responded:
Percentage DK/Ref of all
Surveyed:
5. Do you identify as male, female or transgender?

Male
Female
Male to Female Transgender
1.52
1.47
Female to Male Transgender
Gender*
Number Blank:
Number Responded:
Number Male:
Number Female:
Number Transgender (M to F):
Number Refused:
Percentage Male of Responded:
Percentage Male of all Surveyed:
Percentage Female of Responded:
0
68
100.
00
41
25
1
0
60.2
9
60.2
9
36.7
6
36.7
6
Percentage Female of all Surveyed:

Percentage Transgender (M to F) of
Responded:
1.47
Percentage Transgender (M to F) of all
Surveyed:
1.47
Percentage Refused of Responded:
0.00
Percentage Refused of all Surveyed:
0.00
*1 Response was "Male, Female" and was not
included
6. Are you Hispanic or Latino?

Yes
No
Don't Know/Refused
Ethnicity
Number Blank:
Dont Know/ Refused
Number Responded:
Number Hispanic/Latino:
Number Non-Hispanic/Non-Latino:
Number Refused:
Percentage Hispanic/Latino of Responded:
Percentage Hispanic/Latino of all
Surveyed:
Percentage Non-Hispanic/Non-Latino of
Responded:
Percentage Hispanic/Latino of all
Surveyed:
7. What is your race? (Individual may identify more than one race.)
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other
68
100.0
0
8
60
0
11.76
11.76
88.24
88.24
0.00
0.00
Black or African American

Dont Know/Refused
Race
Number Blank:
Number Responded:
Number White:
Number Black or African American
Number Asian
Number American Indian or Alaska Native:
Number Native Hawaiian or Pacific Islander:
Number Other:
Number Multiple Races:
Number Refused:
Percentage White of Responded:
Percentage White of all Surveyed:
Percentage Black or African American of Responded:
Percentage Black or African American of all Surveyed:
Percentage Asian of Responded:
1
67
98.5
3
2
50
0
1
2
2
8
2
2.99
2.99
74.6
3
74.6
3
0.00
White
Percentage Asian of all Surveyed:

Percentage American Indian or Alaska Native of
Responded:
Percentage American Indian or Alaska Native of all
Surveyed:
Percentage Native Hawaiian or Pacific Islander of
Responded:
Percentage Native Hawaiian or Pacific Islander of all
Surveyed:
Percentage Other of Responded:
Percentage Other of all Surveyed:
Percentage Multiple Races of Responded:
Percentage Multiple Races of all Surveyed:
0.00
1.49
1.49
2.99
2.99
2.99
2.99
11.9
4
11.9
4
2.99
2.99
8. Have you ever served in the United States Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard)?
Yes
No (GO TO QUESTION 10)
Don't Know/Refused
Military by Active Armed

Forces Service
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Percentage No of
Responded:
Surveyed:
Responded:
Surveyed:
0
68
100.
00
1
67
0
1.47
1.47
98.5
3
98.5
3
0.00
0.00
9. Have you ever been called into active duty by the National Guard or as a Reservist?
Yes
No
Don't Know/Refused
Military by Reserve /
National Guard Service
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Surveyed:
Responded:
Surveyed:
15
53
77.9
4
2
50
1
3.77
2.94
94.3
4
73.5
3
1.89
1.47
10. Including this time, how many separate times have you stayed in shelters or on the streets in the past 3 years, that is since January 2012?
Fewer than 4 times
4 times or more times
Don't Know/Refused
Chronic by Number of
Episodes
Number Blank:
Number Responded:
Number Fewer than 4:
Number 4+ Times:
Number DK/Ref:
Percentage Fewer than 4 of
Responded:
8
60
88.2
4
26
28
6
43.3
3
Percentage Fewer than 4 of all

Surveyed:
Percentage 4+ Times of
Responded:
Percentage 4+ Times of all
Surveyed:
Responded:
Surveyed:
11. How long have you been homeless this time?

Less than 1 month
1-6 months
7-11 months
38.2
4
46.6
7
41.1
8
10.0
0
8.82
Full year or more
Chronic by Duration
Number Blank:
Number Responded:
Number <1 Month:
Number 1-6 Months:
Number 7-12 Months:
Number Full Year or More:
Number DK/Ref:
Percentage <1 Month of Responded:
Percentage <1 Month of all Surveyed:
Percentage 2-6 Months of Responded:
Percentage 2-6 Months of all Surveyed:
Percentage 7-12 Months of Responded:
Percentage 7-12 Months of all
Surveyed:
Percentage Full Year or More of
Responded:
Percentage Full Year or More of all
Surveyed:
Percentage DK/Ref of Responded:
8
60
88.2
4
14
20
8
10
8
23.3
3
20.5
9
33.3
3
29.4
1
13.3
3
11.7
6
16.6
7
14.7
1
13.3
3
Don't Know/Refused
11.7
6
Percentage DK/Ref of all Surveyed:
I'm going to ask you some questions that deal with personal health conditions, and your responses are anonymous.
12. Do you drink alcohol regularly?
Yes
No
Don't Know/Refused
Alcohol
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Surveyed:
Surveyed:
Responded:
Surveyed:
1
67
98.5
3
4
62
1
6.06
5.88
93.9
4
91.1
8
1.52
1.47
13. Do you use illegal drugs regularly? This could include prescription drugs not prescribed to you.
Yes
No
Don't Know/Refused
Illegal Drug Use
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
1
67
98.5
3
13
54
0
19.7
0

Surveyed:
Surveyed:
Responded:
Surveyed:
19.1
2
81.8
2
79.4
1
0.00
0.00
14. Do you have any physical disabilities?

Yes
No
Don't Know/Refused
Physical Disability
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Surveyed:
Percentage No of all Surveyed:
Responded:
Surveyed:
0
68
100.0
0
6
62
0
9.09
8.82
93.94
91.18
0.00
0.00
15. Have you ever been diagnosed with a mental health condition, such as Depression or Schizophrenia?
Yes
No
Don't Know/Refused
Mental Health
Number Blank:
Number Responded:
1
67
98.5
3
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Percentage No of
Responded:
Surveyed:
Responded:
Surveyed:
26
41
0
39.3
9
38.2
4
62.1
2
60.2
9
0.00
0.00
16. Do you have any ongoing health issues like cancer, diabetes or heart disease?
Yes
No
Don't Know/Refused
Health Issues
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Surveyed:
Responded:
Surveyed:
17. Have you ever been diagnosed with HIV or AIDS?

Yes
No
Don't Know/Refused
2
66
97.0
6
6
60
9.09
8.82
90.9
1
88.2
4
0.00
0.00
HIV/AIDS
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Surveyed:
Responded:
Surveyed:
1
67
98.5
3
0
66
1
0.00
0.00
98.5
1
97.0
6
1.49
1.47
18. Have you ever been physically, emotionally, or sexually abused by a relative or another person you have stayed with, such as a spouse,
partner, brother or sister, or parent?
Yes
No
Don't Know/Refused
Domestic Violence
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Surveyed:
1
67
98.5
3
29
38
0
43.2
8
42.6
5
56.7
2
55.8
8
0.00
Responded:
Surveyed:
0.00
19. Would you say any of the situations we just discussed prevent you from keeping housing? If so which?
Substance Abuse
Mental Health Diagnosis
Health issue
Physical disability
Physical, emotional, sexual abuse
HIV/AIDS
Dont Know/Refused
No, none of these conditions prevent me from having housing
Situations Pertaining to Homelessness
Number Blank:
Number Responded:
Number MH Disorder:
Number SA Disorder:
Number Physical Disability:
Number HIV/AIDS:
Number Physical Emotional Sexual Abuse:
Number No:
Number Refused:
Percentage MH Disorder of Responded:
Percentage MH Disorder of all Surveyed:
Percentage SA Disorder of Responded:
Percentage SA Disorder of all Surveyed:
Percentage Physical Disability of Responded:
Percentage Physical Disability of all Surveyed:
Percentage HIV/AIDS of Responded:
Percentage HIV/AIDS of all Surveyed:
Percentage Physical Emotional Sexual Abuse of
Responded:
Percentage Physical Emotional Sexual Abuse of
all Surveyed:
Percentage No of Surveyed:
5
63
92.6
5
3
1
1
1
4
52
1
4.76
4.41
1.59
1.47
1.59
1.47
1.59
1.47
6.35
5.88
82.5
4
76.4
7
1.59
1.47
20. I can call a homeless Outreach team and they can pick you up to stay inside tonight. Would you like me to call?
Yes (CALL OUTREACH:215.232.1984)
No
Outreach Call
Number Blank:
Number Responded:
Number Yes:
Number No:
Number DK/Ref:
Percentage Yes of
Responded:
Surveyed:
Surveyed:
Responded:
Surveyed:
11
57
83.8
2
2
55
0
3.51
2.94
96.4
9
80.8
8
0.00
0.00
THANK INDIVIDUAL. REMIND THEM THAT THEIR INFORMATION WILL REMAIN PROTECTED AND
ANYONYMOUS.
ASK IF THEY WOULD LIKE TO PROVIDE THEIR NAME SO OUTREACH CAN FIND THEM FASTER.
FIRST: ___________________________________ LAST:_____________________________________

TEAM MEMBER INITIALS:_________________ TIME COMPLETED: ________________________

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997

2015 Philadelphia Point-in-Time Count Survey

Homeless Outreach Hotline: 215. 232.

Tens Place (00) 0

Ones Place (00) 0

2. Where are you sleeping tonight?

4. How old are you?

4a. If participant is unsure, prompt:

Dont Know/ Refused

5. Do you identify as male, female or transgender?

Female to Male Transgender

Percentage Female of all Surveyed:

6. Are you Hispanic or Latino?

Dont Know/ Refused

Black or African American

Percentage Asian of all Surveyed:

No (GO TO QUESTION 10)

Military by Active Armed

Percentage Fewer than 4 of all

11. How long have you been homeless this time?

Full year or more

Percentage DK/Ref of all Surveyed:

Percentage Yes of all

14. Do you have any physical disabilities?

17. Have you ever been diagnosed with HIV or AIDS?

Yes (CALL OUTREACH:215.232.1984)

FIRST: ___________________________________ LAST:_____________________________________

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