Swan Housing Group

Risk Screening Form

Referral agencies if you have completed a more comprehensive risk assessment though your involvement with the applicant please do not complete this form, but include a copy of your most up to date risk assessment, including triggers and ways to minismise risks.  

If you have not completed a risk assessment then please use this form to highlight any potential/known risks for floating support staff to take into consideration when visiting/assessing the applicant


Environmental

Detail any risk factors relating to the service users accommodation or surrounding areas e.g.







Risk to whom:








Vulnerablility

Detail any risks to the person from others e.g.







Risk to whom:








Risks from the service user

Any known risks to others e.g.







Risk to whom:








Mental Health

Any known risks in this area









Risk to whom:








Drug/alcohol

Any known problems in this area, details of the extent of the problem, whether any help is being sought etc.



Risk to whom:








Other


Risk to whom:








Other Agency Involvement

Please use this space to advise of any other agencies/professionals who are involved with the applicant (continue in last textbox if necessary).






















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