Toolkit with Report Form - Pennsylvania Coalition Against Domestic ...

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Section 1: General Information Program Name: Staff Name: Phone: County: Title/Position: Email: Was the incident contained to one county? Yes No If not, list other county(s): Tier One Incidents – Major incidents, such as domestic violence fatalities, near fatalities, or natural deaths of shelter residents; Requires immediate notification to PCADV by phone along with submission of this form. Tier Two Incidents – Other incidents, such as fires, floods, bed bugs, or no heat in shelter, that disrupt your program’s continuity of services and may attract unwanted media attention; Requires report submission only. Incident Tier Level: 1 2 Date of Incident: Location of Incident: Please provide a brief description of the incident and its impact on services and staff: Please describe how the program was notified: Were there any witnesses? Staff Volunteers Clients Relatives Bystander Law Enforcement U Unknown Children-Ages & How Many: 0-5 6-10 11-13 14-17 Fire Department EMS/Paramedics County Emergency Management Health Department Coroner Other - Please list: 1 PCADV Incident Reporting Procedure 7-1-11/ rev. 4-3-13
Did the Program request crisis intervention/critical supports? KCIT CVVC NOVA/Bucks Other - Please list: Were there any media contacts? If so, please list: Other Funders Notified: PCAR PCCD United Way Other - Please list: Section 3: Continuity of Service How will the program ensure continuity of services? Describe any modification of intake/referral processes for victims in your county in order to access domestic violence services: Section 4: PCADV Follow-Up How can PCADV provide additional supports or assistance? *Tier One Incidents – Major incidents, such as domestic violence fatalities, near fatalities, or natural deaths of shelter residents; Requires immediate notification to PCADV by phone along with submission of this form. Tier Two Incidents – Other incidents, such as fires, floods, bed bugs, or no heat in shelter that disrupt your program’s continuity of services and may attract unwanted media attention; Requires report submission only. 2 PCADV Incident Reporting Procedure 7-1-11/ rev. 4-3-13
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When Crisis Strikes: A Toolkit for
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TABLE OF CONTENTS 1. When Crisis St
Page 6 and 7:
Section ONE PCADV technical Assista
Page 8 and 9:
Section two Involve other systems i
Page 10 and 11:
COMMUNICATIONS Do: Don’t: Do: Don
Page 12 and 13: Responding to Subpoena for Program
Page 14 and 15: Section four PROTECTING CONFIDENTIA
Page 16 and 17: Section four RESPONDING TO A subpoe
Page 18 and 19: Section four ◗ Staff should never
Page 20 and 21: Section five 4. Trauma ◗ A unique
Page 22 and 23: Section five E. Take Care of Staff
Page 24 and 25: Section five A Team Approach Most c
Page 26 and 27: Section five Communication with Fam
Page 28 and 29: Section five Take Care of Staff Fee
Page 30 and 31: Section five Vicarious Trauma Impli
Page 32 and 33: Section five Bringing in Other Indi
Page 34 and 35: Section five Physical Injury Severe
Page 36 and 37: Section five In securing personal i
Page 38 and 39: Section five Children and Death Whe
Page 40 and 41: Section five Appendix Resources Res
Page 42 and 43: Section six Managing Communications
Page 44 and 45: Section Six A Reference Guide to th
Page 46 and 47: Section Six Preparing Victims and S
Page 48 and 49: Section Six DISPELLING MYTHS Myth:
Page 50 and 51: Section Six Myth: Women Lie About B
Page 52 and 53: Section Six Myth: There’s Nothing
Page 54 and 55: Section seven Individual and Commun
Page 56 and 57: Section seven Honoring Victims Prof
Page 58 and 59: Section seven Community Awareness E
Page 60 and 61: Section seven Randi’s Race This a
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Toolkit with Report Form - Pennsylvania Coalition Against Domestic ...

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