Is there a history of any of the following: Safeguarding Children: Yes : No (please): please give details below Has anyone involved in contact been (Refer to family contact procedure re: PPRC - convicted of an offence against children Attach risk assessments if you are promoting (PPRC) contact) Has there been, or is there likely to be, a Yes: No (please): risk of abduction. please give details below (if yes are procedures in place for holding passports) Domestic Violence: Yes: No (please): please give details below (Refer to family contact procedure and attach completed DV pre contact risk assessment as per contact procedure) Alcohol abuse: Yes: No (please): please give details below Sexual Abuse : Yes : No (please): Please give details below (Refer to family contact procedure and attach any specialist risk assessments)
Is there a history of any of the following: Safeguarding Children: Has anyone involved in contact been convicted of an offence against children (PPRC) Yes : please give details below (Refer to family contact procedure re: PPRC - Attach risk assessments if you are promoting contact) No (please): Has there been, or is there likely to be, a risk of abduction. Yes: please give details below (if yes are procedures in place for holding passports) No (please): Domestic Violence: Yes: please give details below (Refer to family contact procedure and attach completed DV pre contact risk assessment as per contact procedure) No (please): Alcohol abuse: Yes: please give details below No (please): Sexual Abuse : Yes : Please give details below (Refer to family contact procedure and attach any specialist risk assessments) No (please):
supervised_contact_referal_form.docx