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: *****