<p> RESTRICTED WHEN COMPLETED </p><p>Nottingham and Nottinghamshire MARAC research form </p><p>Name & Agency</p><p>Telephone / Email Date</p><p>© Copyright CAADA 2010 1 W: www.caada.org.uk T: 0117 3178750 E: [email protected] Registered charity number 1106864 RESTRICTED WHEN COMPLETED </p><p>Amend & highlight any changes / errors / aliases / nicknames etc (victim, perpetrator and children / vulnerable adults in the household) Survivor name Survivor DOB</p><p>Survivor address</p><p>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 </p><p>© Copyright CAADA 2010 2 W: www.caada.org.uk T: 0117 3178750 E: [email protected] Registered charity number 1106864 RESTRICTED WHEN COMPLETED </p><p>Children’s 1. Children’s 1. name(s) / other DOB(s) / other vulnerable adult 2. adults DOB 2.</p><p>3. 3.</p><p>Address Number of children in Household</p><p>© Copyright CAADA 2010 3 W: www.caada.org.uk T: 0117 3178750 E: [email protected] Registered charity number 1106864 RESTRICTED WHEN COMPLETED </p><p>Perpetrator name Perpetrator DOB</p><p>Address</p><p>Does the perpetrator Y / N if No Landlord details: own their Home BMER Disabled LGBT Gender M / F Diversity Data </p><p>© Copyright CAADA 2010 4 W: www.caada.org.uk T: 0117 3178750 E: [email protected] Registered charity number 1106864 RESTRICTED WHEN COMPLETED </p><p>Note records of last sightings, meetings or phone calls.</p><p>Note recent attitude, behaviour and demeanour, including changes.</p><p>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.).</p><p>Other information (e.g. actions already taken by agency to address survivor’s safety).</p><p>What are the survivor’s greatest priorities to address their safety?</p><p>Who is the survivor afraid of? To include all potential threats, and not just primary perpetrator. </p><p>Who does the survivor believe it safe to talk to?</p><p>Who does the survivor believe it not safe to talk to? Child protection plan / referred to social care / CAF / under review. Detail:</p><p>POST MARAC INFROMATION for Agency Representative to note: Information, Actions and outcomes from the MARAC for the agency key worker</p><p>© Copyright CAADA 2010 5 W: www.caada.org.uk T: 0117 3178750 E: [email protected] Registered charity number 1106864</p>