Please submit this notification to the Solihull Child Protection and Review Unitby fax: 0121 788 4331or via secure email:

P.P.R.C.2

PERSON POSING RISK TO CHILDREN
INFORMATION REQUIRED FOR REFERRAL
  • This form is to be used by any Agency referring a person who poses risk to children.
  • Where there is an identified child at risk, details must be entered for an assessment to be undertaken.
  • Where there is no identified child, this referral will be retained for information only.

PLEASE SELECT

information only
(no identified child at risk) / Assessment
(identified child at risk)

DETAILS OF THE REFERRER

agency / location
name / role
contact address
postcode / telephone

DETAILS OF PERSON POSING RISK

family name / first names
address at time of conviction
postcode / dob
gender / ethnicity

DETAIL OF RELEVANT OFFENCE CONCERNING RISK TO CHILDREN

(Include: nature of offence, age of victim(s), relationship to victim(s), location, date of offence / conviction, and description of their behaviour. (Keep victims details anonymous).

DATE AND DETAIL OF SENTENCE IN RELATION TO THIS OFFENCE

DATE / SENTENCE

WHERE OFFENDER IS IN CUSTODY PROVIDE DECISION ONTHE LEVEL OF CONTACT WITH CHILDREN (PROVISIONAL AND/OR FINAL)

DATE OF DECISION / LEVEL OF CONTACT AGREED

CURRENT / PROPOSED COMMUNITY ADDRESS OF THE PPRC

Type of Address

address

/

DETAILS OF ALL KNOWN PERSONS (ADULTS & CHILDREN) RESIDING WITH THE PPRC AT THE COMMUNITY ADDRESS

Name

/

DOB

/

Relationship to subject

PROVIDE DETAILS OF CURRENT OR PLANNED CONTACT WITH CHILD/REN I.E. RELEASE TO FAMILY RESIDENCE / CONTACT WITH MEMBERS OF EXTENDED FAMILY / HOME LEAVE

DETAILS OF ANY CHILD WITH WHOM CONTACT IS CURRENT / INTENDED OR LIKELY

NAME / DOB / AGE / ADDRESS (Identify as confidential from offender if necessary) / RELATIONSHIP / NAME OF PARENT

ANY OTHER INFORMATION RELEVANT TO A RISK ASSESSMENT INC ASSET / OASys RISK ASSESSMENT

HAS THIS CASE BEEN REFERRED TO MAPPA?

/

yes

/

no

If yes provide details of the Offender Manager

SIGNATURE - Please sign and date this form

Signature / Name / Date
Designation
Address