Was the child/ren at the Yes/No (delete as Did the child/ren witness Yes/No (delete as premises when the appropriate) the incident? * appropriate) incident occurred?* Do you consider that Yes/No (delete as If so, have you made Yes/No (delete as there are grounds for appropriate) such a referral? * appropriate) referring the child/ren to safeguarding? * Reason for Referral / Additional Information This section must be completed in full* – Visible high risk (14 ticks or more on CAADA - Yes/No (delete as appropriate) DASH RIC) Comments: MARAC repeat (further incident identified within Yes/No (delete as appropriate) twelve months from the date of the last referral). Comments: If this is a repeat referral, please provide the date it was last at MARAC Potential escalation please explain Yes/No (delete as appropriate) – Comments: Professional judgement Yes/No (delete as appropriate) If the reason for the referral is Professional Comments: Judgement please explain fully why you feel the victim is at risk of murder or serious harm Is the victim aware of MARAC referral? Yes/No (delete as If no, appropriate) why not?* Has consent to the MARAC referral been given? Yes/No (delete as appropriate) Who is the victim afraid of? (to include all potential threats, and not just primary perpetrator) Vulnerability of the victim e.g. physical or learning disability, old age, mental or significant mental illness. Have there been any threats of arson? If so, please give details. Is there any other relevant information from victim or professional that may increase risk levels? Has the victim been referred to any other MARAC Yes/No If yes where / previously? when?
Was the child/ren at the premises when the incident occurred?* Yes/No (delete as appropriate) Did the child/ren witness the incident? * Yes/No (delete as appropriate) Do you consider that there are grounds for referring the child/ren to safeguarding? * Yes/No (delete as appropriate) If so, have you made such a referral? * Yes/No (delete as appropriate) Reason for Referral / Additional Information – This section must be completed in full* Visible high risk (14 ticks or more on CAADA - DASH RIC) Yes/No (delete as appropriate) Comments: MARAC repeat (further incident identified within twelve months from the date of the last referral). If this is a repeat referral, please provide the date it was last at MARAC Yes/No (delete as appropriate) Comments: Potential escalation – please explain Yes/No (delete as appropriate) Comments: Professional judgement If the reason for the referral is Professional Judgement please explain fully why you feel the victim is at risk of murder or serious harm Yes/No (delete as appropriate) Comments: Is the victim aware of MARAC referral? Yes/No (delete as appropriate) If no, why not?* Has consent to the MARAC referral been given? Yes/No (delete as appropriate) Who is the victim afraid of? (to include all potential threats, and not just primary perpetrator) Vulnerability of the victim e.g. physical or learning disability, old age, mental or significant mental illness. Have there been any threats of arson? If so, please give details. Is there any other relevant information from victim or professional that may increase risk levels? Has the victim been referred to any other MARAC previously? Yes/No If yes where / when?