OHG ASB Toolkit - Action Plan

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Case Ref

Complainant details

• Name

• Address
  Address

• Anonymity requested?

  Yes

  No

• Consent to share information signed?

  Yes

  No

Partnership working

• Agencies currently involved

• Agencies to be contactedis apreofessional

• Is a professional mediation service been considered?

  Yes

  No

• If no, please state the reason.

What evidence is required ( multiple choice)

• Select Diary sheets Photographs Witnesses Professional witnesses Audio sound box CCTV Other

  • Diary sheets
  • Photographs
  • Witnesses
  • Professional witnesses
  • Audio sound box
  • CCTV
  • Other

• If 'other' please specify

• Comp/ Witness Support - which of the following will be offered (multiple choice)

  Select Emotional support Support with evidence gathering Security/ safety devices Pre court hearing visit ASB Co-ord. to accompany on hearing date Transport to and from court Specialist waiting room Support post case Other

  • Emotional support
  • Support with evidence gathering
  • Security/ safety devices
  • Pre court hearing visit
  • ASB Co-ord. to accompany on hearing date
  • Transport to and from court
  • Specialist waiting room
  • Support post case
  • Other

• Specify other

Actions required by complainant?

• Actions agreed

Action

• Action

• Deadline

  Date

• If necessary, would you

  Yes

  No

  N/A