Annex 2: Exemplar Initial Case Review Notification
Confidential (when complete)
The designated person within any agency should complete this Initial Case Review Notification and send it electronically by e-mail to the local Adult Protection Committee lead as soon as possible and in any case within ( ) calendar days of first informing the agreed lead.
The Adult Protection Committee lead, on receipt of the written notification should alert other services/agencies/practitioners who are involved that the case has been reported as a potential Significant Case Review. This alert to other services/agencies/ practitioners can be by telephone, e-mail or fax etc.
These other services/agencies will then be requested to submit an Initial Case Review Report by the Adult Protection Committee lead.
All Initial Case Review Notification Reports received by the Adult Protection Committee lead will be acknowledged.
Adult's Name/Identifier, Adult's Date of Birth and Adult's Gender;
Adult's Home Address &/or Current Residence;
Name of Adult's Next of kin/Carers and their Address/s if different;
Grounds on which the criteria for a Significant Case Review may have been met:
Evidence on which this is based:
Are there any immediate concerns? If so, who have these been passed to for consideration/action?
Are there any general concerns? If so, who have these been passed to for consideration?
Summary of the case
Name of Service/Agency/Professionals Involved with the Adult:
Any other statutory proceedings underway or completed?
Is another local authority involved, including cross border?