Part B Risk Assessment Form 1. Is the applicant verbally, Physically or Sexually Aggressive? YES / NO Please state any details 2. Is this behaviour towards others or the environment? YES / NO Please state any details 3. Are there any known risks at the applicants address/ what are they if YES / NO any? Please state any details 4. Does the applicant self harm/ any eating disorders etc? Have they YES / NO attempted suicide, if so when – how – why? Please state any details 5. Has the applicant any previous mental health issues? Do they YES / NO currently have a mental health worker? Please state any details 6. Has the applicant got / had any history of drug/alcohol or solvent YES / NO dependency? (including prescription drugs) Please state any details 7. Has the applicant had any criminal convictions? YES / NO (including arrests even if they have not led to conviction) Please state any details 8. Has the applicant had any previous criminal history of sex or YES / NO domestic violence offences? (including arrests even if they have not led to conviction) Please state any details 9. Does the applicant have any contact with any other agencies i.e. YES / NO Probation, Bail Order, Out on Licence, Social Services? Please state any details 10. Is the applicant vulnerable to abuse from others or do they YES / NO represent a threat of abuse to others? Please state any details 11. How long is it since they perpetrated abuse? (physical, emotional, sexual) Please state any details 12. Are there any other risks/recent history which have not been YES / NO identified? Please state any details
Part B Risk Assessment Form 1. Is the applicant verbally, Physically or Sexually Aggressive? YES / NO Please state any details 2. Is this behaviour towards others or the environment? YES / NO Please state any details 3. Are there any known risks at the applicants address/ what are they if any? YES / NO Please state any details 4. Does the applicant self harm/ any eating disorders etc? Have they attempted suicide, if so when – how – why? YES / NO Please state any details 5. Has the applicant any previous mental health issues? Do they currently have a mental health worker? YES / NO Please state any details 6. Has the applicant got / had any history of drug/alcohol or solvent dependency? (including prescription drugs) YES / NO Please state any details 7. Has the applicant had any criminal convictions? (including arrests even if they have not led to conviction) YES / NO Please state any details 8. Has the applicant had any previous criminal history of sex or domestic violence offences? (including arrests even if they have not led to conviction) YES / NO Please state any details 9. Does the applicant have any contact with any other agencies i.e. Probation, Bail Order, Out on Licence, Social Services? YES / NO Please state any details 10. Is the applicant vulnerable to abuse from others or do they represent a threat of abuse to others? YES / NO Please state any details 11. How long is it since they perpetrated abuse? (physical, emotional, sexual) Please state any details 12. Are there any other risks/recent history which have not been identified? YES / NO Please state any details