Prevention and Response to Sexual Exploitation & Abuse in Liberia
Prevention and Response to Sexual Exploitation & Abuse in Liberia
Prevention and Response to Sexual Exploitation & Abuse in Liberia
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GBV CASES/INCIDENTS MONTHLY REPORT FORM<br />
PSYCHOSOCIAL<br />
County: ___________________________________________ District: __________________________________<br />
Organization/Agency: ________________________________ Report<strong>in</strong>g Month: _______________ Year: ________<br />
Referrals<br />
Cases<br />
Reported<br />
Cases<br />
Occurred<br />
Follow<br />
ups<br />
Security/<br />
Protection<br />
Legal Med.<br />
Number of NEW Cases Reported<br />
Perpetra<strong>to</strong>r Information<br />
PEP<br />
25 yrs Unknown Start<br />
72 25 yrs Unknown<br />
’04<br />
M F M F M F M F M F M F hrs hrs M F M F M F M F M F M F<br />
Type of Incident<br />
Attempted Rape<br />
Rape<br />
Gang Rape<br />
D/Violence<br />
FGM Complication<br />
<strong>Sexual</strong> Assault<br />
S/<strong>Exploitation</strong><br />
F/Prostitution<br />
Forced marriage<br />
Total<br />
24<br />
Please report below if you have any cases/<strong>in</strong>cidents that do not belong <strong>to</strong> the above listed categories, <strong>and</strong> if you observe certa<strong>in</strong> noteworthy trends <strong>in</strong> cases/<strong>in</strong>cidents reported <strong>to</strong> you.<br />
Cases Referred <strong>to</strong> Other Oganiation/Agency<br />
Cases Received by Referral<br />
25 yrs Unknown<br />
Organization/Agency No. of Cases<br />
Organization/Agency No. of Cases<br />
M F M F M F M F M F M F<br />
Type of Incident<br />
Note: The number of cases/<strong>in</strong>cidents reported reflects services provided <strong>to</strong> GBV survivors <strong>and</strong> not the actual number of GBV cases/<strong>in</strong>cidents; i.e. different services providers can report on the same<br />
cases/<strong>in</strong>cidents.<br />
GBV Cases/Incident Report Form 2007
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