Young Person Information Please ask the YP the following questions. The YP may decline to answer. In which country were you born? CONVENOR CHECKLIST In whichPlease country complete was your a separate mother checklist born? for each young person. Attach Preparation Running Sheets InConference which country Convenor was your father born? Date received by CC What language(s) do you speak at home? Young Person’s Name Preparation hours Are you Aboriginal? Yes No AreDate you notice Torres served Strait on Islander? Method Yes of serving NoSelect Areyoung you personboth Aboriginal & Torres Strait Islander? notice Yes to young person No IfConference not, what is dateyour ethnic origin? Expected start time Declined to answer? Yes No EntryConference Assessment venue Highlight the description that best fits28 the day young expiry person’s date present circumstances. Where you are unable to make a selection please provide details as to the young person’s present circumstances. Issue Yes / No Does the young person have safe and secure accommodation? Yes No TheWere rule any is thatWHS a youngrisks/hazards person who identified is homeless, during or preparation? at risk of homelessness, is not inYes safe, and No secure, accommodation.Venue Safety Examples Inspection of situationsAttached? where (If applicable)a young person is safe and secure are: If theyYes live in a No home with parents; in a home with relatives/significant others; in a refuge placement; in a medium to long term youth accommodationDo any participants service; have in independent additional support living (shared needs? accommodation or individual accommodation);Yes No in a rehabilitation service; in a DFACS placement or NGO working with DFACS clients; Other:Are any participants from a CALD or ATSI background? Yes No IsIs the an younginterpreter person required participating for any participant? in employment? Yes Yes No No A young person is participating in employment if they are involved in: a traineeship or apprenticeship; employed part time;Has employedany person full been time; excluded participating from in participation volunteer work in (workthe YJC? experience); participatingYes in an No Aboriginal Employment Program; self employed; working with family or significant others; engaged with an employment service (hasHave a case you manager) had face-to-face with strong contactprospects with of gaining all key employment participants? Yes No Other:Have any factors been identified as contributing to the young person’s Is the young person participating in Education & Training? Yes No offending behaviour e.g. mental health issues, AOD use, barriers to Yes No Aeducation young person etc? is participating in education & training if they are: attending school (part or full time), participating in a distant education program, participating in a “back to school” program, attending TAFE, attending university, attendingHave you a special made educationany reports program, to Family attending & Community an education Services program regardingas part of theira employment, attending trainingchild, as and/or part of young their AOD person; Program, you attending have an had Aboriginal contact training with program, during theattending a learning to drive program, attending a parenting program, attending a land care or environmental program, attending any program thatpreparation involves learning of this a new conference? skill. If yes, details of report must be recorded on Yes No Other:running sheet and reported to the AM. Refer to YJC Client Protection & Wellbeing procedures Is the young person participating in Community Activities? Yes No AHas young the person young is participatingperson any in outstanding Community activities fines? ifIf theyyes are: playing sport, attending Yesa youth centre No or familyYes centre,Has permission attending the been PCYC, obtained participating to contact in volunteer Revenue work or NSW? program, attending church or religious No or spiritual growth group, involved in drama or theatre group, involved in learning art, involved in learning music, involved in a culturalFrom which program agency or activity, has isthe a young member person of a communityreceived legal group advice? or charity, attends NarcoticsSelect or Alcoholics Anonymous, participates in their local community activities (e.g. Blue Light discos, Surf club or skate) Other:Invited participants Refer to Section 47, Young Offenders Act 1997. For previously unknown invitees Ifplease the response add their full to details any toof the the Participant Entry Assessment Contact Details questions section. is ‘NO’ please provide explanatoryTitle information:Name Role Contact Number Expected to attend? Select Yes No Select Yes No Select Yes No Select Yes No Select Yes No Select Yes No Consent Form- Young Person.Select Ensure that you have obtained the young person’s Yesconsent using No the Consent Form prior to making any referralsSelect to external agencies. Yes No Select Yes No Select Yes No Select Yes No
Convenor Checklist Page 1 of 5 Information & Referrals – Young Person Compete the following if you have referred a young person to an external agency during the course of preparation.
Referral Date Referral Type Referral Referral Outcome Referral Outcome Reason Reason Select Select Select Select Referred to Name Referred to Position Location Referral Date Referral Type Referral Referral Outcome Referral Outcome Reason Reason Select Select Select Select Referred to Name Referred to Position Location Referral Date Referral Type Referral Referral Outcome Referral Outcome Reason Reason Select Select Select Select Referred to Name Referred to Position Location Referral Date Referral Type Referral Reason Referral Outcome Referral Outcome Reason Select Select Select Select Referred to Name Referred to Position Location Additional information (optional)
Information & Referrals – Victim Compete the following if you have referred a victim to an external agency during the course of preparation. Referral Date Referral Type Referral Reason Referral Outcome
Select Select Select
Select Select Select
Select Select Select
Did you discuss the pamphlet and services offered by Victims Yes No Services NSW with the victim(s)? Additional information (optional)
Convenor Checklist Page 2 of 5 Young Person’s checklist Young people to complete and sign.
It has been explained to me and I understand that:
The goals of the conference are for me to hear from the person(s) affected by my offence(s) and to agree on how I can repair the harm I have caused.
I can nominate a support person to be with me at the conference.
I do not have to agree to an outcome plan that I find unacceptable.
Any outcome I agree to must be realistic and achievable.
I am legally obliged to carry out the agreements I make at the conference.
Your signature
Your name
Date
Thank you for providing this information.
Convenor Checklist Page 3 of 5
Victim checklist Victims of crime to complete and sign.
It has been explained to me and I understand that:
The goals of the conference are for the young person to fully understand the harm they have caused and to agree on how they can repair this harm.
I may nominate a support person to be with me at the conference.
I am not obliged to agree to any outcome plan that I find unacceptable.
Any outcome agreed by the young person must be realistic and achievable, given their age and level of development
I am obliged to keep the details of the conference confidential, including the identity of those present.
If I choose not to personally attend the conference, I can send a representative on my behalf.
If I choose not to attend the conference or send a representative, I can contribute via a letter, video or audio recording.
I understand that by not personally attending the conference I forfeit my right to veto the outcome plan.
Your signature
Your name
Date
Thank you for providing this information.
Convenor Checklist Page 4 of 5 Participant Contact Details Update the details of any invited participant as required. Name Role Select Street No. & Street Town/Suburb Post Code Telephone Email Name Role Select Street No. & Street Town/Suburb Post Code Telephone Email Name Role Select Street No. & Street Town/Suburb Post Code Telephone Email Name Role Select Street No. & Street Town/Suburb Post Code Telephone Email CONVENOR DECLARATION 1. To the best of my knowledge the information provided throughout this Convenor Checklist represents an accurate record of the preparatory work that I have undertaken as the Conference Convenor appointed to prepare and facilitate the youth justice conference. 2. I have reported any potential conflict of interest to the Assistant Manager and complied with agreed strategies to manage such a conflict of interest. 3. I have canvassed with all potential participants their preference for date, time and venue of the conference. All participants have been notified (in writing where required) and are aware of this date, time and place. 4. I have undertaken all preparation tasks as required per YJC polices and the Administration of YJC procedure.
Convenor Signature: Date: OFFICE USE ONLY If received electronically, print and attach to client file.
Checklist Received Date: ______Conference approved to proceed YES NO Assistant Manager Signature______Date: ______
Convenor Checklist Page 5 of 5