Multi-Agency Public Protection Arrangements (MAPPA):national guidance 2016

MAPPA Document 2

MAPPA Referral Form Level 2 / Level 3 (please delete)

PERSONAL DETAILS

Name:

ALIAS:

DOB:

Age:

Gender: MALE / FEMALE:

Race & Ethnic Origin:

Prison No:

PNC No:

SCRO No:

ViSOR No:

Current Address / Release Address:

Previous Significant Address:

Agency / Establishment Referring:

Referred by:

Job Title:

Contact Tel No:

Date of Referral:

Is the offender aware of the referral? If not why

REASON FOR REFERRAL

Please give brief details of reasons for referral e.g. index offence, behaviour causing concern, rise in risk level, etc.

COURT AND LICENCE / ORDER DETAILS

Index Offence

Sentencing Court:

Sentence date:

Sentence / Order details:

If in custody earliest release date:

Licence expiry date:

Sentence expiry date:

Details of any other statutory order:

i.e. SOPO, OLR, RSHO, CORO etc

Status in Criminal Justice System - including any outstanding court dates:

Please give details ( e.g. Bail, Community Sentence)

Full contact details of Supervising Officer / Police Offender Manager:

Name, Job Title, Address, Telephone, E-mail

Scottish Prison Service

Additional information - associates, sexualised behaviour whilst in custody, substance misuse, access to finance, etc.

SUMMARY OF OFFENDING BEHAVIOUR

1. PATTERN - Based on previous convictions and other information, outline since when, how often and how much particular types of harmful behaviour have occurred. Highlight violent and sexual offences and any incidents which occurred in prison/hospital. Please attach a record of previous convictions:

2. NATURE - Outline what types and how many types of offending that are evident. Give details regarding known or potential victims (specifying any risk to children, vulnerable adults and threats to staff) and any requirements under the terms of the Victim Notification Scheme or engagement with Victim Support Scotland:

3. SERIOUSNESS - What is known about the degree of planning and the intended and actual impact of the offending?:

4. LIKELIHOOD - Comment on the balance of risk and protective factors. Is the balance in favour of desistance or further offending? What is the nature and seriousness of further offending likely to be? Refer to current or most recent risk assessment:

REASON FOR RECOMMENDING LEVEL? (PLEASE PROVIDE EVIDENCE AS TO WHY IT IS BEING RECOMMENDED THIS INDIVIDUAL IS TO BE MANAGED AT LEVEL.)

LIST OF ATTACHMENTS

e.g. CHS record

ANY OTHER INFORMATION IF APPROPRIATE

Signature:

Date of completion: