Bristol MARAC
dvmaracbristol@avonandsomerset.pnn.police.uk

Restricted when completed

REFERRAL FOR BRISTOL MARAC
Please send by secure e-mail to dvmaracbristol@avonandsomerset.pnn.police.uk
Please include completed DASH
PLEASE COMPLETE ALL SECTIONS       HANDWRITTEN REFERRALS/DASHs AND PDFS NOT ACCEPTED.

Always refer to referral guidance to ensure MARAC referral is appropriate and completed correctly.

All cases referred to MARAC must also be referred to DVA Services For IDVA support.
In Bristol, Victims can access IDVA support from Next Link, Victim Support IDVAs, BRI IDSVAs, One25 IDSVA, OPOKA	
Victim:   
	Perpetrator:  	
Name:
		Name		
DOB:		Ethnicity		DOB		
Disability		Disability		
Full Address of Victim:
Including full post code	Full Address of Perpetrator:	
		
	Relationship to Victim		

Telephone:  

Is it Safe to contact?  	
Issues with drugs and/or alcohol? – Victim and/or Perpetrator?
	
Name of GP Surgery: 		
Is the person referred aware of the MARAC?
(Must inform them if it is safe to do so)	 
	If not, why not?	
	Has the victim given consent?

You can still refer without consent if DA is high risk.	
	
Children 
Names and Dates of Birth:	DOB	Address:	Relationship to victim:	Relationship to Perpetrator:	Disability or any other relevant info:	

Names of schools/Early Years Setting for each child, if known.	

N/A	
Identified risks to the victim	Identified risks to the children	Identified risks to the perpetrator	
			
Date DA Disclosure made to referrer:
	Date DASH risk assessment completed: 
(Please include DASH with your referral)

Which specialist DV Support Agency has the victim been referred to?
If unable to refer victim to DVA Support Agency, please provide full rationale. 

	

REFERRAL CRITERIA:
Follow attached guidance to avoid referral being returned to you
MARAC process serves victims at risk of an imminent event which is life-threatening and/or traumatic, whether physical or psychological and where there are identifiable indicators of risk of serious harm. The potential event could happen at any time and could be serious.	

DASH Risk Assessment
There are identifiable indicators on the DASH of a risk of serious harm being inflicted in the immediate future. 	

DASH submitted with referral form Y/N
Please provide rationale if DASH not completed

Professional Judgement
(please complete fully to avoid return of referral)

As a professional you have a serious concern about a victim’s situation. 

	

Line management sign off required:

Potential Escalation

Increase in reported incidents. 	
Have there been 3 or more police callouts in a 12 month period?

Repeat case to MARAC

Further incident of DVA has occurred between a couple previously discussed at MARAC within the last 12 months. 

Date of last MARAC multiagency discussion:

Reason for referral: Summary of Incident/disclosure – please provide the dates of any incidents if possible.
(Maximum 250 words if possible -  use bullet points)	
. 

What actions have been completed to safeguard the victim and children?	

The below are example actions that can be arranged without information sharing or discussion at a MARAC meeting.
Please tick / highlight the actions that have been completed thus far 

Safety measure	

Victim engagement with IDVA      	

Emotional support     	

Liaise with agencies to gather information and discuss safety plan 	

Advise in social media privacy/Holly guard app 	

Letter for Legal Aid 	

Referral to children safeguarding, family support 	

Referral to Adult Social Care	

Housing issues 	

School informed of DA 	

Police aware 	

Welfare check 	

Neighbours alerted 	

Home safety addressed/’target hardening’	

Victim updated on prosecution 	

Flag/marker on agencies system 	

Victim refuge/Safe house option explored	

•	If the victim requires a MARAC letter for legal aid or housing this can be written by any member of a MARAC group or the Victim’s IDVA.

Please only refer to MARAC if there is a clear need for multi-agency information sharing and multi-agency safety planning.
	
What action does the victim require from MARAC?

Victim’s Voice

	

	
	
Name of Referring Officer and Agency:  		
	
Contact Details of Referrer:
	
Telephone: 
		
Email:
MUST be secure.		
Address:

END