OHG ASB Risk Assessment form

• Client / Site

• Conducted on

  Date
• Location
  Address

History

• Other than this occasion, how often do you have problems?

  Daily

  Most days

  Most weeks

  Most Months

  Occasionally

• Do you think the current incident is linked to previous incidents?

  Yes

  No

• Do you think the incidents are happening more often and/or getting worse?

  Not at all

  Affected a little

  Moderately affected

  Affected a lot

  Extremely affected

• Do you know the alleged perpetrator?

  Yes

  No

• Does the alleged perpetrator ( or associates) have a history of or reputation for intimidation or harassment?

  currently harassing

  harassed in the past

  have history of harassment

  no history

• Have you informed other agencies about what has happened? If yes are you happy for us to discuss this problem with them?

  Yes

  No

Vulnerability

• Which of the following do you think that this incident is targeted at? Please specify in the box below

  You

  Your family

  Your community

  None

• Add any specific information in this box

• Do you feel this incident is associated with any of the following?

  Select Faith Nationality Ethnicity Sexuality Gender Disability

  • Faith
  • Nationality
  • Ethnicity
  • Sexuality
  • Gender
  • Disability

• Add details here

• In addition to what has happened, do you feel that there is anything that is increasing you or your households personal risk

  Yes

  No

• Add details here

Support

• How affected do you feel by what has happened?

  Not at all

  Affected a little

  Moderately affected

  Affected a lot

  Extremely affected

• Has your health or anyone's else's health been affected as a result of this and any previous incidents?

  Physical health

  Mental health

  No

• Do you have a social worker, health visitor or any other professional support? Can we speak to them about this?

  Yes

  No

• Add contact details here

• Do you have any friends or family to support you

  Complainant lives alone and is isolated

  The complainant is isolated from people who can offer support

  The complainant has a few people to draw on for support

  the complainant has a close network of people to draw on support

• Apart from any effect on you, do you think anyone else has been affected by what has happened?

  Your family

  Local community/other

• Using your judgement and using the slide indicate what level of risk this person should be given. Do not lower the score

Action plan - complete and sign the relevant section

• HIGH - I believe that the ASB is having an adverse impact on the person in question which includes risk of harm, deterioration of health, mental/ emotional well being or inability to carry out normal day to day routine through fear and intimidation.

• Name

• Add your signature

  Sign

• ACTION -
  Immediately pass the Risk Assessment to the Regional Head of Housing Operations or Housing Manager.
  Immediately take all possible steps to reduce the risk of harm.
  Ensure that relevant multi agency support is in place

• Medium - I believe that the ASB does not at this stage carry risk of harm, deterioration of health, mental/ emotional well being or inability to carry out normal day to day routine through fear and intimidation.

• Name

• Add your signature

  Sign

• ACTION -
  Forward completed Risk Assessment to ASB Coordinator/ Senior Housing Officer
  Ensure that relevant multi agency support is in place.
  Monitor changes in risk factors weekly/ fortnightly, agreed by ASB Coordinator or SHO

• LOW - I believe that the ASB does not at this stage carry risk of harm, deterioration of health, mental/ emotional well being or inability to carry out normal day to day routine through fear and intimidation.

• Name

• Add your signature

  Sign

• ACTION -
  Ensure that relevant multi agency support is in place
  Monitor changes in risk factors at each 28 day review

• A new risk assessment form must be completed at every 28 day review at a minimum