Annex 3: Exemplar Initial Case Review Report
Confidential (when complete)
As requested agencies/services should complete this Initial Case Review Report and send it electronically by e-mail to the Adult Protection Committee lead as soon as possible and in any case within ( ) calendar days. This report should contain relevant information pertaining to the agencies/service contact/interaction with the subject or person. Each agency/service will submit details of their own involvement with the subject or person. All Initial Case Review Reports received by the Adult Protection Committee lead will be acknowledged.
Date to be completed:
Date returned to designated officer:
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;
1. Summary of involvement:
2. Background (include relevant issues e.g. health, disability, cultural, religious, sexual orientation, legal status and previous concerns or referrals re adult support and protection):
3. Outline of key issues including:
- Were there strategies and actions to minimise harm?
- Was there evidence of Information sharing?
- Was there recognition and assessment of risk?
- Was there evidence of planning?
- How good was the record keeping?
4. Practice Issues Please identify known good practice as well as any known areas for improvement.
Any particular sensitivities (e.g. from the Procurator Fiscal or Police about cases where there are likely to be disciplinary proceedings):
5. Recommendation Please highlight any areas which may require further consideration:
6. Decisions made and reasons
Case Review No:
Date of review report:
7. Case review group
Options to be considered:
8. Adult Protection Committee
Date notified of decision:
Note of discussion by Adult Protection Committee:
9. Chief Officers
Date notified of above decision:
Note of any comments/discussion by Chief Officers: