INDIRECT/DIRECT REPARATION INITIAL ASSESSMENT


    Young Person’s Personal Information & Health and Safety Checklist.

    Date of initial assessment


    Name of person filling in this assessment



    PERSONAL AND MEDICAL INFORMATION

    Young person’s name


    Young person’s Contact number


    Name of parent / guardian / carer


    Has the young person’s parent / guardian / carer seen or contributed to this assessment?

    YesNo

    Emergency contact details


    Current address

    Is the young person in secure / suitable accommodation?


    Yes

    Supported shared housingSupported self contained accommodationLocal authority accommodationBed and breakfast with supportFamily homeFriend’s / relations home with supportFoster care / supported lodgings

    No

    Does this young person suffer from a medical condition that would require regular medication?

    AsthmaADHDEpilepsyDyslexiaDiabetesLearning DifficultiesHay feverDisabilitiesOther

    Does the young person have any current or previous injuries which may affect the type of reparation they are able to engage in?

    YesNo

    Does the young person suffer from any allergies (e.g. peanuts, wasp stings, penicillin, plasters, hay fever, vinyl gloves etc)

    YesNo



    EDUCATION EMPLOYMENT TRAINING

    Is the young person currently (or due to start in the next 28 days) in:

    Education

    Full TimePart Time

    Training

    Full TimePart Time

    Employment

    Full TimePart Time

    Availability

    PURPOSEFUL ACTIVITY

    Are you currently involved in any of out of school activities/volunteering (Please provide details)

    YesNo

    Other interests/hobbies

    REPARATION DETAILS

    Has this young person engaged in reparation previously?(tick box)

    YesNo

    ASDAN offered?

    YesNo

    Details

    Reparation Project

    Is this young person prepared to work in a group setting?

    YesNo

    Is this young person consenting to photographs being taken and possibly being used for display/evidence files whilst undertaking reparation?

    YesNo

    Consent to share

    In accordance with the new General Data Protection Regulation 2018 and the Data Protection Act 2018, Catch22 requires your consent to conduct referrals to support your needs identified within the initial assessment. By signing below you consent that all relevant and appropriate information can be shared by your Reparation Officer & Reparation Manager with all internal and external agencies such as Bristol Youth Offending Team, Reparation Projects and any Safeguarding professionals. Due to the nature of the work completed by Catch22, your Reparation Manager will be in contact with your Caseworker regarding attendance and behaviour whilst on Reparation and any safeguarding disclosures.

    I understand that I have agreed with my Reparation Manager/Officer Referrals can be made and information can be shared as stated above. I understand that the information is being shared with a view to ensuring and assisting my continuity of care in the community. I understand that Catch22 will keep all information gathered in a secure environment and for only as long as necessary, adhering strictly to all requirements of the General Data Protection Regulation 2018 and the Data Protection Act 2018. However once the referring agency is in receipt of your information they will become the Data controller and hold your information going forward.

    ALL PAPERWORK IS SHREDDED AFTER REPARATION IS COMPLETED

    Is this young person consenting to photographs being taken and possibly being used for display/evidence files whilst undertaking reparation?

    YesNo

    Signature of Young Person:

    Signature of Reparation Officer:

    Signature of Parent/Guardian/Carer: