1.Address of site:
_____________________________________________________________________
2.How many occupants at location: _____________________________________________________________________
3.Occupants names and ages: _____________________________________________________________________
_____________________________________________________________________
4.Occupants occupations: _____________________________________________________________________
_____________________________________________________________________
5.Occupants religious beliefs: _____________________________________________________________________
_____________________________________________________________________
6.Time of occupancy at the location:
_____________________________________________________________________
7.Age of the site:
_____________________________________________________________________
8.How many previous owners:
_____________________________________________________________________
9.History of site: (tragedies, deaths,
previous complaints) _____________________________________________________________________
_____________________________________________________________________
10.How many rooms in the site:
_____________________________________________________________________
11.Has the location been blessed:
_____________________________________________________________________
12.Has there been any recent remodeling:
_____________________________________________________________________
13.Any occupants on medication:
_____________________________________________________________________
14.Any occupants using illegal drugs:
_____________________________________________________________________
15.Any occupants drink alcohol heavily:
_____________________________________________________________________
16.Any occupants interested in the
occult: (ouija, seances, psychics, spells) _____________________________________________________________________
_____________________________________________________________________
17.Any occupants currently seeing a
psychiatrist: _____________________________________________________________________
18.Have any religious clergy been consulted:
_____________________________________________________________________
19.Has there been any media involvement:
_____________________________________________________________________
20.Have there been any other witnesses
besides the occupants: ______________________________________________________________________
____________________________________________________________________
21.Have there been any odors:
(perfumes, flowers, sulfur, excreetment) ______________________________________________________________________
______________________________________________________________________
___________________________________________________________________
22.Have there been any sounds:
(footsteps, knocks, banging) _______________________________________________________________________
_______________________________________________________________________
_________________________________________________________________
23.Have there been any voices:
(whispering, yelling, crying, speaking) _______________________________________________________________________
_______________________________________________________________________
_________________________________________________________________
24.Has there been any movement of objects:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
25.Has there been any levitations:
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
26.Have there been any uncommon cold
or hot spots: _________________________________________________________________________
_________________________________________________________________________
_____________________________________________________________
27.Have there been any problems with
electrical appliances: (TV, lights, kitchen appliances, doorbells)
___________________________________________________________________________
___________________________________________________________________________
_________________________________________________________
28.Have there been any problems with
plumbing: (leaks, flooding, sinks, toilet bowls) ____________________________________________________________________________
____________________________________________________________________________
_______________________________________________________
29.Any occupants having nightmares
or trouble sleeping: ____________________________________________________________________________
____________________________________________________________________________
_______________________________________________________
30.Have there been any physical attacks:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________
31.Are pets affected: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________
32.When was the first occurance of
the phenomena: _____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________
33.What was the witnesses reaction
during the phenomena: ______________________________________________________________________________
______________________________________________________________________________
___________________________________________________
34.How long was the duration of the
phenomena: ______________________________________________________________________________
______________________________________________________________________________
___________________________________________________
35.Who first witnessed the phenomena:
_____________________________________________________________________
36.Were there any other witnesses:
_____________________________________________________________________
.What time was the first occurance
of the phenomena: _____________________________________________________________________
.How often does the phenomena occur:
_______________________________________________________________________________
_______________________________________________________________________________
_________________________________________________
.Do the occupants feel the phenomena
is threatening: ________________________________________________________________________________
________________________________________________________________________________
_______________________________________________
.What do the occupants believe is happening:
(is it supernatural) ________________________________________________________________________________
________________________________________________________________________________
_______________________________________________
41.Do all of the occupants agree on
what is happening or do they think it’s nonsense: ________________________________________________________________________________
________________________________________________________________________________
_______________________________________________