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REFERRAL TO MAPPA LEVEL 2/3
Fields marked with * are mandatory
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MAPPA A
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Name of MAPPA area:
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Referral to which level?
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2
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3
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1. CATEGORY OF OFFENDER
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* All agencies
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The offender can fall into only one of the MAPPA Categories summarised below. Please place an X against only one of the following three Categories.
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1. Registered Sexual Offender
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2. Violent or other sexual offender:
Who has been sentenced to 12 months or more custody for an offence under Sch.15 of the Criminal Justice Act 2003; or
Who has been sentenced to 12 months or more custody and is transferred to hospital under s.47/49 of the Mental Health Act 1983; or
Who has been detained in hospital under s.37 of the Mental Health Act 1983 with or without a restriction order under s.41.
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3. Other dangerous offender – has been cautioned for or convicted of an offence which indicates that he or she is capable of causing serious harm AND which requires multi-agency management. This might not be for an offence under Sch.15 of the Criminal Justice Act 2003.
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2. OFFENDER INFORMATION
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Last name:
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* All agencies
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First name:
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* All agencies
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Date of birth:
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* All agencies
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Aliases
(including nicknames):
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All agencies
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Prison:
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All agencies
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Prison number:
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All agencies
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Last known address before sentence:
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All agencies
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Proposed release address:
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* All agencies
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Current address if in community:
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* All agencies
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Gender:
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* All agencies
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Ethnicity:
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* All agencies
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PNC ID:
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Police / Probation
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ViSOR Reference
(must be completed for all Registered Sexual Offenders):
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Police / Probation
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Agency unique identifier:
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All agencies
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3. CONVICTION / CAUTION INFORMATION
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Index offence / Relevant caution:
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* All agencies
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Date of conviction / caution:
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* All agencies
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Sentence:
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All agencies
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Brief offence(s) details:
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* All agencies
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Relevant previous convictions and pattern of offending:
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All agencies
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Other relevant information:
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All agencies
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Relevant dates
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Automatic Conditional Release Date:
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YOT / Probation
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Parole Eligibility Date:
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YOT / Probation
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Non-Parole Date:
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YOT / Probation
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Licence Expiry Date:
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YOT / Probation
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Sentence Expiry Date:
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YOT / Probation
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Home Detention Curfew:
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YOT / Probation
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Community Order end date:
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YOT / Probation
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Disqualification Order:
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YES / NO
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* Police
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Imprisonment for Public Protection:
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YES / NO
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* Probation
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Extended Sentence for Public Protection:
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YES / NO
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* Probation
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Lifer:
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YES / NO
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* YOT / Probation
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Mental Health review date(s):
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Mental Health
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Sexual Offences Prevention Order:
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YES / NO
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* Police / Probation
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Registered Sex Offender Notification end date:
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Police / Probation
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Violent Offender Order:
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YES / NO
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* Police
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4. DETAINED IN HOSPITAL
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Mental Health
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Name of responsible clinician:
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Hospital:
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Earliest possible discharge date:
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Proposed release address:
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Name / contact details of Forensic Social Worker:
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Date of next tribunal:
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Please indicate the basis for detention from the options below
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Guardianship order – s.7/s.37 MHA 1983
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YES / NO
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Hospital order –
s.37 MHA 1983
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YES / NO
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Restriction order –
s.41 MHA 1983
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YES / NO
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Transfer from prison –
s.47 MHA 1983
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YES / NO
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5. RISK ASSESSMENT
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RM 2000 Risk of Reconviction [complete for all sexual offenders]
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Police / Probation
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Level
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Date of assessment
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RM 2000 Sexual:
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RM 2000 Violent:
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RM 2000 Combined:
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OASys Risk of Reconviction
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Prison / Probation
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1 year %
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2 year %
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Band
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Date completed
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OGP:
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OVP:
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OGRS3:
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OASys Risk of Serious Harm – (1) Risk in the Community
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Prison / Probation
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V High
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High
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Medium
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Low
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Date completed
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Children:
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Public:
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Known adult:
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Staff:
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Prisoners:
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OASys Risk of Serious Harm – (2) Risk in Custody
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Prison / Probation
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V High
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High
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Medium
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Low
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Date completed
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Children:
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Public:
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Known adult:
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Staff:
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Prisoners:
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SARA Assessment [complete for all domestic abuse offenders]
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Probation
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High
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Medium
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Low
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Date completed
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Risk to partner:
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Risk to others:
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ASSET Risk of Serious Harm [complete for all offenders under 18]
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YOT
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V High
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High
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Medium
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Low
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Date completed
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Risk of serious harm:
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ASSET risk of reconviction
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Date completed
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Mental Health / Psychological Risk Tool
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Mental Health
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Date completed
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Lead Agency Risk Assessment Summary
(Take this information from the Lead Agency Risk Management Tool)
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* All agencies
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Who is at risk?
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What is the nature of the risk?
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When is the risk likely to be greatest?
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What circumstances are likely to increase risk?
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What factors are likely to reduce the risk?
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Lead Agency Risk Management Plan
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* All agencies
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Restrictive factors / interventions
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Rehabilitative factors / interventions
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Protective factors / interventions
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6. RELEVANT INFORMATION
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* All agencies
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Reason for referral
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What inter-agency work has been undertaken so far?
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How will active multi-agency management add value to the management of the risk(s) of serious harm?
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Diversity considerations linked to risk of serious harm
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Add any other relevant information (e.g. media handling, disclosure, medical issues etc)
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7. VICTIM CONCERNS
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All agencies
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Outline any concerns about the victim of the index offence or potential victims:
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Has the victim taken up the Victim Liaison Service?
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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If YES, give contact details of VLO
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Are there any domestic abuse concerns? If YES, answer a to e below
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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a. What are they?
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b. Has the victim been referred to MARAC?
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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c. Has a meeting been held / Is a meeting due to be held?
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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d. Date of meeting (if known)
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e. Actions from MARAC
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8. SAFEGUARDING
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All agencies
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Child Protection Concerns (continue on additional sheet if required)
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Are there any child protection concerns? If YES, answer a to c below
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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a. What are they?
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b. Is there an allocated social worker? If so, please give details
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c. Is the child or children currently subject to a Child Protection Plan?
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YES / NO / NOT APPLICABLE / NOT KNOWN *
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Child 1
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Last name:
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First name:
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Date of birth:
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Gender:
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Relationship to offender:
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Child 2
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Last name:
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First name:
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Date of birth:
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Gender:
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Relationship to offender:
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Child 3
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Last name:
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First name:
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Date of birth:
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Gender:
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Relationship to offender:
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Vulnerable Adult Concerns (continue on additional sheet if required)
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Name:
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Date of birth:
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Gender:
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Does this person live with the offender?
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YES / NO
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Relationship to offender:
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Name of social worker (if relevant):
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9. REFERRING AGENCY INFORMATION
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Referring agency:
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*
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Name:
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*
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Grade:
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*
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Office:
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*
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Telephone number(s)
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* (w)
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(m)
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Email address:
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*
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Date sent to line manager:
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Endorsement by line manager (where required by your area)
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Name:
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Grade:
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Office:
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Telephone number(s):
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(w)
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(m)
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Email address:
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Date endorsed by line manager:
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10. ADDITIONAL MAPPA INVITEES
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All agencies
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Invitee 1
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Invitee 2
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Invitee 3
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Invitee 4
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Invitee 5
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Invitee 6
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Name:
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Agency:
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Address:
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Email address:
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Telephone number(s)
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(w)
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(m)
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Once completed, please send this form to the MAPPA Co-ordination Unit.
ONLY USE SECURE EMAIL
Insert your email address here
If email is not secure, please fax to: Insert your fax number here
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Date sent:
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11. MAPPA CO-ORDINATION UNIT DECISION (for official use only)
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Screened by:
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Name:
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Title:
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Area:
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Date referral received:
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MAPPA qualifying offender?
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YES / NO
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If NO, return form to referring agency line manager
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Comments:
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Does referral meet threshold for Level 2/3?
If YES, which level?
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If NO, return form to referring agency line manager
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Comments:
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Date referral accepted / rejected:
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Date referring agency notified:
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Meeting to which referral is to be taken:
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