29.06.2014 Views

National guidance for child protection in Scotland - Scottish ...

National guidance for child protection in Scotland - Scottish ...

National guidance for child protection in Scotland - Scottish ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

8. Reason <strong>for</strong> referral<br />

Brief<strong>in</strong>g taken from<br />

Contact details<br />

Names of persons present dur<strong>in</strong>g brief<strong>in</strong>g<br />

Location of assault(s)<br />

History of events (cont<strong>in</strong>ue overleaf if necessary)<br />

CSA Checklist<br />

Penis to mouth?<br />

Mouth to genitalia?<br />

Penis to anus?<br />

Penis to vulva/vag<strong>in</strong>a?<br />

Details<br />

Object to vulva/vag<strong>in</strong>a/anus?<br />

Details<br />

Kiss<strong>in</strong>g/lick<strong>in</strong>g/bit<strong>in</strong>g?<br />

Details<br />

Injuries? details<br />

Ano-genital bleed<strong>in</strong>g?<br />

Weapon used?<br />

Damage to cloth<strong>in</strong>g?<br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

Yes No <br />

56

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!