Thank You for Providing This Information
Please complete a separate checklist for each young person. Attach Preparation Running Sheets
Conference Convenor / Date received by CC
Young Person’s Name / Preparation hours
Date notice served on young person / Method of serving notice to young person / SelectHand deliveredPostLeft at YP's address
Conference date / Expected start time
Conference venue / 28 day expiry date
Issue / Yes / No
Were any WHS risks/hazards identified during preparation? / Yes No
Venue Safety Inspection Attached? (If applicable) / Yes No
Do any participants have additional support needs? / Yes No
Are any participants from a CALD or ATSI background? / Yes No
Is an interpreter required for any participant? / Yes No
Has any person been excluded from participation in the YJC? / Yes No
Have you had face-to-face contact with all key participants? / Yes No
Have any factors been identified as contributing to the young person’s offending behaviour e.g. mental health issues, AOD use, barriers to education etc? / Yes No
Have you made any reports to Family & Community Services regarding a child, and/or young person; you have had contact with during the preparation of this conference? If yes, details of report must be recorded on running sheet and reported to the AM. Refer to YJC Client Protection & Wellbeing procedures / Yes No
Has the young person any outstanding fines? If yes
Has permission been obtained to contact Revenue NSW? / Yes No Yes No
From which agency has the young person received legal advice? / SelectLegal Aid HotlinePrivate SolicitorChildren's Legal ServiceAboriginal Legal HotlineLegal Aid SolicitorNo Legal advice sought
Invited participants Refer to Section 47, Young Offenders Act 1997. For previously unknown invitees please add their full details to the Participant Contact Details section.
Title / Name / Role / Contact Number / Expected to attend?
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
SelectYoung PersonPerson responsible for childYP Family memberAdult chosen by YPLegal PractitionerIOSYOVictimVictim RepresentativeVictim SupportPolice Officer (Training)Respected member of communityInterpreterSchool representativeDisability support personSocial worker/Health professionalJuvenile Justice supervisorPerson requested by YP's family / Yes No
Convenor Checklist Page 1 of 1
Young Person Information Please ask the YP the following questions. The YP may decline to answer.In which country were you born?
In which country was your mother born?
In which country was your father born?
What language(s) do you speak at home?
Are you Aboriginal? / Yes No
Are you Torres Strait Islander? / Yes No
Are you both Aboriginal & Torres Strait Islander? / Yes No
If not, what is your ethnic origin?
Declined to answer? / Yes No
Entry Assessment Highlight the description that best fits the young person’s present circumstances. Where you are unable to make a selection please provide details as to the young person’s present circumstances.
Does the young person have safe and secure accommodation? Yes No
The rule is that a young person who is homeless, or at risk of homelessness, is not in safe, and secure, accommodation. Examples of situations where a young person is safe and secure are: If they live in a home with parents; in a home with relatives/significant others; in a refuge placement; in a medium to long term youth accommodation service; in independent living (shared accommodation or individual accommodation); in a rehabilitation service; in a DFACS placement or NGO working with DFACS clients;
Other:
Is the young person participating in employment? Yes No
A young person is participating in employment if they are involved in: a traineeship or apprenticeship; employed part time; employed full time; participating in volunteer work (work experience); participating in an Aboriginal Employment Program; self employed; working with family or significant others; engaged with an employment service (has a case manager) with strong prospects of gaining employment
Other:
Is the young person participating in Education & Training? Yes No
A young person 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, attending a special education program, attending an education program as part of their employment, attending training as part of their AOD Program, attending an Aboriginal training program, attending a learning to drive program, attending a parenting program, attending a land care or environmental program, attending any program that involves learning a new skill.
Other:
Is the young person participating in Community Activities? Yes No
A young person is participating in Community activities if they are: playing sport, attending a youth centre or family centre, attending the PCYC, participating in volunteer work or program, attending church or religious or spiritual growth group, involved in drama or theatre group, involved in learning art, involved in learning music, involved in a cultural program or activity, is a member of a community group or charity, attends Narcotics or Alcoholics Anonymous, participates in their local community activities (e.g. Blue Light discos, Surf club or skate)
Other:
If the response to any of the Entry Assessment questions is ‘NO’ please provide explanatory information:
Consent Form- Young Person. Ensure that you have obtained the young person’s consent using the Consent Form prior to making any referrals to external agencies.
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 Reason / Referral Outcome / Referral Outcome Reason
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther ServicesMandatory Reporting / SelectReferral AcceptedReferral in ProgressReferral Not Accepted / SelectYP meets service criteriaUnable to provide serviceYP considered risk to other service recipientsYP did not attend assessmentYP not eligible for serviceYP not in geographical area of SPYP requires other support before receiving serviceYP unable to participateYP unwilling to participate
Referred to Name / Referred to Position
Location
Referral Date / Referral Type / Referral Reason / Referral Outcome / Referral Outcome Reason
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral AcceptedReferral in ProgressReferral Not Accepted / SelectYP meets service criteriaUnable to provide serviceYP considered risk to other service recipientsYP did not attend assessmentYP not eligible for serviceYP not in geographical area of SPYP requires other support before receiving serviceYP unable to participateYP unwilling to participate
Referred to Name / Referred to Position
Location
Referral Date / Referral Type / Referral Reason / Referral Outcome / Referral Outcome Reason
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral AcceptedReferral in ProgressReferral Not Accepted / SelectYP meets service criteriaUnable to provide serviceYP considered risk to other service recipientsYP did not attend assessmentYP not eligible for serviceYP not in geographical area of SPYP requires other support before receiving serviceYP unable to participateYP unwilling to participate
Referred to Name / Referred to Position
Location
Referral Date / Referral Type / Referral Reason / Referral Outcome / Referral Outcome Reason
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral AcceptedReferral in ProgressReferral Not Accepted / SelectYP meets service criteriaUnable to provide serviceYP considered risk to other service recipientsYP did not attend assessmentYP not eligible for serviceYP not in geographical area of SPYP requires other support before receiving serviceYP unable to participateYP unwilling to participate
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
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral acceptedService provider unable to provide serviceNo follow up conductedIneligible for service
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral acceptedService provider unable to provide serviceNo follow up conductedIneligible for service
SelectAboriginal Legal ServicesAgeing, Disability and Home CareCentrelinkChild Wellbeing Unit (CWU)Community ServicesDepartment of Education and TrainingDepartment of HealthHousing NSWJustice HealthLegal Aid NSWNGOState Debt Recovery Office / SelectAccommodation ServicesAOD ServicesDisability ServicesEducation ServicesEmployment ServicesIncome Support ServicesLegal ServicesMental Health ServicesOther Services / SelectReferral acceptedService provider unable to provide serviceNo follow up conductedIneligible for service
Did you discuss the pamphlet and services offered by Victims Services NSW with the victim(s)? / Yes No
Additional information (optional)
Convenor Checklist Page 1 of 1
Young Person’s checklist Young people to complete and sign.ü / 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.
ü / 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 1 of 1
Participant Contact Details Update the details of any invited participant as required.Name / Role / SelectYoung PersonVictimYP Parent/CarerVictim Parent/Carer
Street No. & Street
Town/Suburb / Post Code
Telephone / Email
Name / Role / SelectYoung PersonVictimYP Parent/CarerVictim Parent/Carer
Street No. & Street
Town/Suburb / Post Code
Telephone / Email
Name / Role / SelectYoung PersonVictimYP Parent/CarerVictim Parent/Carer
Street No. & Street
Town/Suburb / Post Code
Telephone / Email
Name / Role / SelectYoung PersonVictimYP Parent/CarerVictim Parent/Carer
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 1 of 1