Nottingham and Nottinghamshire MARAC Research Form

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Nottingham and Nottinghamshire MARAC research form

Name & Agency

Telephone / Email Date

Amend & highlight any changes / errors / aliases / nicknames etc (victim, perpetrator and children / vulnerable adults in the household) Survivor name Survivor DOB

Survivor address

Does the survivor own their Home Y / N if No Landlord details: MARAC case number (from MARAC Repeat case to MARAC Y / N List) BMER Disabled LGBT Gender M / F Diversity Data Yes No Has a referral to Refs Yes No Animals Is a pet(s) in the house for Pets been done

Children’s 1. Children’s 1. name(s) / other DOB(s) / other vulnerable adult 2. adults DOB 2.

3. 3.

Address Number of children in Household

Perpetrator name Perpetrator DOB

Address

Does the perpetrator Y / N if No Landlord details: own their Home BMER Disabled LGBT Gender M / F Diversity Data

Note records of last sightings, meetings or phone calls.

Note recent attitude, behaviour and demeanour, including changes.

Highlight any relevant information that relates to any of the risk indicators on the checklist (e.g. the pattern of abuse, isolation, escalation, survivor’s greatest fear etc.).

Other information (e.g. actions already taken by agency to address survivor’s safety).

What are the survivor’s greatest priorities to address their safety?

Who is the survivor afraid of? To include all potential threats, and not just primary perpetrator.

Who does the survivor believe it safe to talk to?

Who does the survivor believe it not safe to talk to? Child protection plan / referred to social care / CAF / under review. Detail:

POST MARAC INFROMATION for Agency Representative to note: Information, Actions and outcomes from the MARAC for the agency key worker