| Please explain that the purpose of asking these questions is for the safety and protection of the individual concerned.\nTick the box if the factor is present ☑. Please use the comment box at the end of the form to expand on any answer.\nIt is assumed that your main source of information is the victim. If this is not the case please indicate in the right hand column | Yes (tick) | No | Don't Know | State source of info if not the victim e.g. police officer |
| 1. Has the current incident resulted in injury?\n(Please state what and whether this is the first injury.) | ☐ | ☐ | ☐ | |
| 2. Are you very frightened?\nComment: | ☐ | ☐ | ☐ | |
| 3. What are you afraid of? Is it further injury or violence? (Please give an indication of what you think (name of abuser(s)...) might do and to whom, including children).\nComment: | ☐ | ☐ | ☐ | |
| 4. Do you feel isolated from family/friends i.e. does (name of abuser(s) .....) try to stop you from seeing friends/family/doctor or others?\nComment: | ☐ | ☐ | ☐ | |
| 5. Are you feeling depressed or having suicidal thoughts? | ☐ | ☐ | ☐ | |
| 6. Have you separated or tried to separate from (name of abuser(s)...) within the past year? | ☐ | ☐ | ☐ | |
| 7. Is there conflict over child contact? | ☐ | ☐ | ☐ | |
| 8. Does (.....) constantly text, call, contact, follow, stalk or harass you?\n(Please expand to identify what and whether you believe that this is done deliberately to intimidate you? Consider the context and behaviour of what is being done.) | ☐ | ☐ | ☐ | |
| 9. Are you pregnant or have you recently had a baby (within the last 18 months)? | ☐ | ☐ | ☐ | |
| 10. Is the abuse happening more often? | ☐ | ☐ | ☐ | |
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| 11. Is the abuse getting worse? | ☐ | ☐ | ☐ | |
| 12. Does (.....) try to control everything you do and/or are they excessively jealous? (In terms of relationships, who you see, being ‘policed at home’, telling you what to wear for example. Consider ‘honour’-based violence and specify behaviour.) | ☐ | ☐ | ☐ | |
| 13. Has (.....) ever used weapons or objects to hurt you? | ☐ | ☐ | ☐ | |
| Tick box if factor is present. Please use the comment box at the end of the form to expand on any answer. | Yes (tick) | No | Don’t Know | State source of info if not the victim |
| 14. Has (.....) ever threatened to kill you or someone else and you believed them? (If yes, tick who.)
You ☐ Children ☐ Other (please specify) ☐ | ☐ | ☐ | ☐ | |
| 15. Has (.....) ever attempted to strangle/choke/suffocate/drown you? | ☐ | ☐ | ☐ | |
| 16. Does (.....) do or say things of a sexual nature that make you feel bad or that physically hurt you or someone else? (If someone else, specify who.) | ☐ | ☐ | ☐ | |
| 17. Is there any other person who has threatened you or who you are afraid of? (If yes, please specify whom and why. Consider extended family if HBV.) | ☐ | ☐ | ☐ | |
| 18. Do you know if (.....) has hurt anyone else? (Please specify whom including the children, siblings or elderly relatives. Consider HBV.)
Children ☐ Another family member ☐
Someone from a previous relationship ☐ Other (please specify) ☐ | ☐ | ☐ | ☐ | |
| 19. Has (.....) ever mistreated an animal or the family pet? | ☐ | ☐ | ☐ | |
| 20. Are there any financial issues? For example, are you dependent on (.....) for money/have they recently lost their job/other financial issues? | ☐ | ☐ | ☐ | |
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| 21. Has (.....) had problems in the past year with drugs (prescription or other), alcohol or mental health leading to problems in leading a normal life? (If yes, please specify which and give relevant details if known.)
Drugs ☐ Alcohol ☐ Mental Health ☐ | ☐ | ☐ | ☐ | |
| 22. Has (.....) ever threatened or attempted suicide? | ☐ | ☐ | ☐ | |
| 23. Has (.....) ever broken bail/an injunction and/or formal agreement for when they can see you and/or the children? (You may wish to consider this in relation to an ex-partner of the perpetrator if relevant.)
Bail conditions ☐ Non Molestation/Occupation Order ☐
Child Contact arrangements ☐
Forced Marriage Protection Order ☐ Other ☐ | ☐ | ☐ | ☐ | |
| 24. Do you know if (.....) has ever been in trouble with the police or has a criminal history? (If yes, please specify.)
DV ☐ Sexual violence ☐ Other violence ☐ Other ☐ | ☐ | ☐ | ☐ | |
| Total ‘yes’ responses | |
| For consideration by professional: Is there any other relevant information (from victim or professional) which may increase risk levels? Consider victim’s situation in relation to disability, substance misuse, mental health issues, cultural/language barriers, ‘honour’- based systems and minimisation. Are they willing to engage with your service? Describe:
Consider abuser’s occupation/interests - could this give them unique access to weapons? Describe:
What are the victim’s greatest priorities to address their safety? |
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| Risks | Triggers | Agency to feedback to IP |
| VICTIM:
Physical ☐
Emotional ☐
Threats ☐
Intimidation ☐
Sexual ☐
Isolation ☐ | Alcohol ☐
Drugs ☐
Child contact ☐
Controlling behaviours ☐
Jealousy ☐
Mental Health ☐
Bereavement ☐
Loss of employment ☐ | Police ☐
Haven IDVA ☐
WDVF IDVA ☐
CJSS IDVA ☐
Health ☐
Children’s Social Care ☐
Adult Social Care ☐
MAST Education ☐
Adult Safeguarding ☐
Probation ☐
Mental Health ☐
Substance Misuse ☐
Children’s Centres ☐
DV Specialist Midwife ☐
ASB Housing ☐
OMU ☐
CAMHS | ☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐ |
| CHILDREN:
Physical ☐
Emotional ☐
Threats ☐
Intimidation ☐
Sexual ☐
Isolation ☐ | Action planning:
(The action plan should clearly identify and address the risks and needs identified and be SMART; where appropriate they should include joint working and refer to other multi-agency arrangements) |
| Risk identified | Action | By Agency Representative | Completion date |
| | | |
| | | |
| | | |
| | | |
| All Actions to be completed by DATE and recorded on Action Tracking Form and returned by email to MARAC Coordinator: ***** |
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## Appendix 5 - Quick Reference Guide for All Agencies
Ideally, the information should be gathered by a police or social care trained specialist.
However there may be occasions when an individual is going overseas imminently and as it is an emergency an education/probation /health/social care staff may need to gather as much information as possible from the victim.
In these cases, the information should be passed on to Police, Children's Services or Adult Social Care and the Ministry of Justice Forced Marriage Unit. All information should be securely stored in accordance with the Safeguarding policies and procedures.
It is important to get as much information as possible when a case is first reported, as there may not be another opportunity for the person to make contact (see the “one chance rule”).
Obtain details of the person making the report, their contact details, and their relationship with the individual under threat
Obtain details of the person under threat including:
○ Date of report
○ Name of person under threat
○ Nationality
○ Age
Date and place of birth
O Alias names / known as names
Passport details
○ School/ College details (if appropriate)
○ Employment details
○ Full details of the allegation
○ Name and address of parents or those with parental responsibility
○ National Insurance number
○ Driving licence number
Obtain a list from the person under threat of all those friends and family who can be trusted and their contact details
Establish a code word to ensure you are speaking to the right person
Obtain any background information including education attended, involvement by adult or children's social care, doctors or other health services etc.
Record details about any threats, abuse or other hostile action
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against the person, whether reported by the victim or a third party
Obtain a recent photograph and any other identifying documents.
Document any other distinguishing features such as birthmarks and tattoos etc.
- Establish the nature and level of risk to the safety of the person (e.g. is she pregnant? Do they have a secret boyfriend or girlfriend? Are they already secretly married?)
Establish if there are any other family members at risk of forced marriage or if there is a family history of forced marriage and abuse.
## Information required if the Individual is going overseas imminently
• A photocopy of their passport for retention. Encourage them to keep
details of their passport number and the place and date of issue.
As much information as possible about the family (this will need to be gathered discreetly, including:
○ Full name and date of the person under threat
○ Their father's name
○ Do you need to insert flight details if known
○ Any address where they may be staying overseas
Potential spouse's name (if known)
Date of the proposed wedding (if known)
○ The name of the potential spouse's father (if known)
○ Addresses of the extended family in the UK and overseas.
Information that only the person would be aware of (if the victim is a British national, this may assist any subsequent interview at an Embassy/British High Commission in case another person of the same age and gender is produced pretending to be them)
Details of any travel plans and people likely to accompany them
- Names and addresses of any close relatives remaining in the UK
- A safe means by which contact may be made with the person e.g. a
mobile telephone that will function overseas. Record the number
Details of the third party in order to maintain contact in case the person contacts them whilst overseas or on her return
An estimated return date. Ask that the person contacts you on their return
A written statement by the person explaining that they want the police, adult or children's social care, a teacher or a third party to act on their behalf if they do not return by a certain date.
## Remember:
If the family are approached, they may deny that the person is being forced to marry, move them, expedite any travel arrangements and bring forward the forced marriage.
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## As part of the Protection Plan you will consider the following:
Encourage the person to get in touch with the Forced Marriage Unit. The Unit gives confidential advice and support to anyone who fears they may be forced to marry.
## The person may be a dual national and have two passports
If foreign travel with the family becomes unavoidable, in addition to the “information required”, the following precautions should be taken:
Give the person contact details of the department and practitioner handling their case
Encourage the person to memorise at least one telephone number and e-mail address preferably (if they are a British national) those of the British Embassy or British High Commission. Supply the address and contact number for the nearest British Embassy or High Commission
If they are not a British national, advise them to contact the Forced Marriage Unit (page 20). The Unit can provide details of reliable Non-Governmental Organisations (NGOs) overseas and the details of the relevant Embassy
- Advise them to take a mobile phone that will work overseas (one which is capable of international roaming) and which they can keep hidden
Encourage them to give you details of a trusted friend/advocate in the UK who they will be keeping in touch with whilst overseas, who will act on their behalf, and whom you can approach if they do not return. Make contact with the friend/advocate before the person under threat departs and request the friend/advocate make a written statement of their support
- Advise them to take emergency cash, in the local currency and in hard currency (pounds, dollars, euros), in case problems arise in the country of destination, together with contact details of someone there they can trust to help them
• Ascertain whether the person has two passports and if so, which one they will be travelling on. Explain the implications of dual nationality.
Give them a copy of the Forced Marriage Unit's leaflet - Forced Marriages Abroad.
- Advise them to contact the Forced Marriage Unit and give contact details.
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