| Full Name: | |
| Type of establishment (Residence/Commercial): | |
| Contact email or phone number: | |
| Age range of occupants: | |
| Age of site: | |
| Duration of occupancy: | |
| History of site (tragedies, deaths, previous complaints): | |
| Any recent remodeling: | |
| Any occupants interested in the occult (ouija, seances,
pyschics, spells): | |
| Have there been any odors (perfumes, flowers, sulfur,
excrement): | |
| Have there been any sounds (footsteps, knocks, banging): | |
| Have there been any voices (whispering, yelling, crying,
speaking): | |
| Has there been any movement of objects: | |
| Have there been any abnormal cold or hot spots: | |
| Have there been any physical attacks: | |
| When was the first occurance of phenomena: | |
| Any particular time of day phenomena occurs: | |
| How often does phenomena occur: | |
| Are pets affected: | |
| Do any occupants feel threatened: | |
| |
