saynotofear

break-free from violence & abuse

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Risk Assessment Tool

This is a standalone risk assessment tool - any data entered into this form will NOT be saved. If you are going to report a crime, you will be asked to fill a risk assessment tool in, where the data will be saved alongside any other info you provide.

PLEASE NOTE: You do not have to fill in every box.

Sexual Violence Form

1. Was there more than one perpetrator?
2. Is the perpetrator/are any of the perpetrators known to the service user?
3. Does/do the perpetrator(s) know where service user lives/ works/studies or their movements etc?.
4. Does/do the perpetrator/s have a criminal record?
5. If there any protective orders or bail and/or licence conditions in place etc is/are the perpetrator/s non compliant (or do they have a history of no compliance previously) with these restrictions?
6. Has the victim experienced sexual violence on more than one occasion?
7. Has the service user/victim experienced domestic and/or sexual violence previously from any other perpetrator as an adult or child?
8. Is the service user involved, or have they been previously involved, in working in the sex industry?
9. Has the assault, or any previous assault committed by this perpetrator, involved the use of weapons?
10. Did the perpetrator(s) threaten to kill anybody? (please tick all that apply)



11. Has the perpetrator (if known by the service user/victim or agencies) got a history of lighting fires/arson, or threatened to use fire to abuse the victim/children/family/ friends/ others?
12. Was the service user/victim stalked prior to/or post, the assault? (Behaviour includes: following them, phone calls or texts, use of social networking sites, checking their whereabouts, contacting their family/friends/workplace, turning up where they are etc)
13. If a known perpetrator (to either the victim or the system) do they have any of the following? (please tick all that apply)



14. Did the perpetrator attempt to strangle, choke, suffocate, drown or otherwise restrict the breathing of the service user/victim during this assault/previous assaults (including other victims)?
15. Is the service user/victim frightened, or afraid of further injury or violence?
16. Does the service user feel isolated from family/friends or other support/help?
17. Does the service user/victim feel particularly isolated because of any personal, diversity or cultural issues? (Consider physical and/or learning disability, offending behaviour, faith, culture, language, age, mental health, sexual orientation, gender reassignment, honour based codes etc.)
18. Does the service user have current problem with/history of problems with of any of the following? (please tick all that apply)


19. Does the service user/victim have a history of self harm/ express suicidal thoughts, or have they ever made suicide attempts?
20. Does the service user use social networking/instant messaging sites?
21. Has the assault resulted in physical injuries?
22. Does the service user appear not to understand the seriousness of their situation, and/or level of risk posed by the perpetrator/s?
23. Police Callouts in last 12 months?