Confidential when Complete

DATE: CRIME / NON CRIME No:

OFFENCE(S):

VICTIM DETAILS

Has Victim been heard at MARAC before ? NO ☐ Date of Last MARAC

Has Victim consented to be discussed at MARAC? YES ☐ NO ☐ If not, why? :

NAME DATE of BIRTH

ADDRESS POSTCODE GENDER Female

ETHNICITY

SAFE CONTACT TELE No:

SIG MARKER YES ☐

INJURY CODE FATAL ☐ SERIOUS ☐ SLIGHT ☐ NONE ☐ WEAPONS ☐ THREATS ☐

CHILDREN(S) DETAILS

CHILD’S NAME DATE of BIRTH Relationship to Victim Relationship toOffender Children’s Address School (if known)

INJURED ☐ WITNESSED ☐ USED AS SHEILD ☐

OFFENDER DETAILS

NAME DATE of BIRTH

ADDRESS POSTCODE GENDER

ETHNICITY

ARRESTED

DISPOSAL : CHARGED/REMANDED ☐

PNC MARKERS : IOM : YES ☐ NO ☐ SCORE: LOW ☐ MEDIUM ☐ HIGH ☐