Multi-Agency Risk Assessment Document

Multi-Agency Risk Assessment Document

Name
D.o.B
Address
Care First
Pupil ID
Patient ID
Next of Kin
Emergency Contact
Key Worker
Date of completion
Date of review
Individuals consulted as part of the process:
Name / Job Title / Service / Contact Number

Introduction

Risk Index

Risks being considered:

Identified Risk / Yes/No / Level of risk* / Consequence*
1. Physical aggression
2. Verbal aggression
3. Sexualised behaviour
4. Absconding risks
5. Manipulation of carers
6. Vulnerability
7. Transporting risks
8. Medical/health risks
9. Theft or taking possessions
10. Personal care
11. False complaints or accusations
12. Community participation
13. Non-compliance
14. Moving and handling
15. Fire Evacuation
16. Outdoor Equipment
17. Other:

*Refer to key

Key for level of risk (state how often e.g. 2x weekly, 5x daily):

Likely – will occur daily

Probable – will occur weekly

Possible – will occur monthly

Improbable – will occur yearly

Key for consequences:

Minor - person able to manage own behaviour with minimal staff/carer input. Largely self-managed. Able to be managed in situ or time out areas and is unlikely to be a threat to self or others.

Moderate – behaviour will need staff/carer input on a 1:1 basis to diffuse the situation. Distraction techniques will work the majority of time and can not be self managed.

No need for restraint or physical intervention.

Severe – behaviour management will need 1:1 or more.

Staff/carer will need to be trained to handle aggression or difficult behaviour.

It is very likely to result in physical harm to person, carer/staff, public, siblings or property.

It is very likely to result in restraint if no other techniques are able to work.

Person will need to be removed from situation.

It is likely to result in a fatality or serious injury.

Risk may be wholly unacceptable and should be avoided.

1. Physical Aggression
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
2. Verbal Aggression
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
3. Sexualised behaviour
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
4. Absconding risks
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
5. Manipulation of carers
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
6. Vulnerability
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
7. Transporting risks
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
8. Medical/health risks
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
9. Theft or taking possessions
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
10. Personal care
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
11. False complaints or accusations
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
12. Community participation
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
13. Non-compliance
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
14. Moving and handling
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
15. Fire Evacuation
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
16. Outdoor Equipment
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.
17. Other
Form
Who Affected
Triggers
Level of Risk / likelihood
Consequences
Risk management plan
Detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.

Concluding notes.

1. General presentation

1. Likely causes of behaviour deterioration

1. Importance of following guidelines

1. Recording and monitoring of behaviours and risk

1. Importance of understanding diffusion and intervention strategies

1. Awareness of diagnosis and behaviour

1. Knowledge of appropriate interventions and training.

1. Adaptations that may be required to relevant environments and training needed for their operation.

1. Regular multidisciplinary team reviews to evaluate care plan and behaviour management resources.

Record any disagreements, reasons why and outcomes.

Name / Reason for disagreement / Outcomes
Risk assessment distributed to:
Name / Job Title / Service / Contact Number
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:
Assessments agreed by:
Designation:
Date:

Update document

Name:

D.o.B:

Professional updating plan ……………………….

Reason for update.

Highlighted risk ………………………….

Form

Who affected

Triggers

Level of risk/likelihood

Consequences.

Behaviour management plan and strategies.

Under each heading detail how the risk will be managed taking into account the consequences. Detail actions carers should take. Detail actions that should be taken should the plan not work.

Yes / No

Multi-agency agreement

Distribution date ……………………………

Signed by ……………………….

Date ………………………………