BG Hub Interaction Form

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Account Manager

Personal Details

Forename*

Surname*

Postcode:

Building Name:

Secondary Name:

Street:

District:

Town:

County:

Household status*

Mobile

Young person / Adult*

Are you digitally excluded?

No access to the internet

No access to phone

Unable to use a PC

Unable to use a mobile phone

Who is the advice for?

Are you visiting the Hub for yourself?*

Yes No

Reason for visit

What is the reason for your visit today?*

Employment Support

Interested in training opportunities

ASB issue

Welfare benefits

Repairs

Debt/rent arrears & Queries

Looking for home

Energy advice

NYT

Neighbourhood housing officer

Drop off keys/signed documentation

Complaint

Safeguarding

Damp & Mould concerns

Evidence to support a housing application

Housing IAG

Other IAG

Additional information

How long did you spend with visitor? (mins)*

Do you have any specific support needs to be able to access our services?

Deaf

Visually impaired

Physical disability

ESOL

Learning difficulty

Mental health

Emotional & behavioural regulation

Other

Has this person received support from the IAG advisor today?*

Yes No

Is there any further action required for this customer?*

Yes No

What was the customer resolution ?*

NGT Outcomes Framework

Category	Outcome	Notes	Date Achieved	Doc