Safety and Support (SAS) Assessment for ISVAs
D1Personal & Individual
Requirements
D2 Harm from Other(s)
D3 Health & Medical
D4 Mental Health &
Psychological Wellbeing
D5 Coping Mechanisms, Social
& Cultural Support
Age
Communication
Gender Identity
Sexuality
Religious/Cultural Needs
Physical disabilities
Learning disability
Involvement in Sex Work
When abuse took place
About the perpetrator
(Unwanted) contact
Those connected to the
perpetrator
Domestic abuse
Child Sexual Exploitation
(CSE)
Violence Against Women &
Girls
Previous abuse
Client concern
Urgent medical attention
Forensic medical
examination
Sexual & Reproductive
Health
Medical Appointments
Medicines
History of mental health
problems
Current mental health
conditions
Self harm
Suicide
Positive coping skills
Negative coping skills
Social Networks
Cultural Support
Other areas of life
D6 Alcohol & Drug Use
D7 Safeguarding
D8 Criminal Justice
D9 Employment &
Education
D10 Finance
Presence of
children/vulnerable adults
Client concerns
Pregnant client
Involvement of
adult/children’s services
Reporting Options
Support during Investigation
Preparing for court
Support at Court
After the trial
CICA
Employment Status
Education Status
Employer/Education
Provider Awareness
Special/Mitigating
Circumstances
Sources of income
Welfare benefits
Debts
Financial Assistance
NRPF
Drug/alcohol abuse
Coping mechanisms
Substance misuse services
D11 Accommodation &
Housing
Adequate Housing
Safe & Secure Housing
Homelessness
NRPF
D12 Immigration &
Residence
Immigration Status
Undocumented Migrant
NRPF
Trafficking
Detention/Deportation
D13 Risk to Professionals &
Services
D14 Professional Judgment
Physical safety of ISVA
Lone Working arrangements
Other service providers
Refusal of service provision
Any other information
Client perception of risk
Non-verbal communication
Gut instinct or suspicion
Scoring
0 - No risk or needs identified.
1 - Mild Risk or Needs identified
that can be managed by the
client
2 - Moderate Risk or Needs
identified that can be
managed by the ISVA Service
3 - Significant Risk or Needs
identified that require support
from other services
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 1 : Personal and Individual Requirements
Information Summary
Risks Identified
Actions
Age
Communication
Gender Identity
Sexuality
Religious/Cultural
Needs
Physical
disabilities
Needs Identified
Learning
disability
Involvement in
Sex Work
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 2 : Harm from Others
Information Summary
Risks Identified
Actions
When the abuse
took place
About the
perpetrator
(Unwanted)
contact
Those connected
to the perpetrator
Needs Identified
Domestic abuse
Child Sexual
Exploitation (CSE)
Violence Against
Women & Girls
Score
Previous abuse
Client concerns
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 3 : Health & Medical
Information Summary
Risks Identified
Actions
Urgent medical
attention
Forensic medical
examination
Sexual &
Reproductive
Health
Needs Identified
Medical
Appointments
Medicines
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 4 Mental Health & Psychological Wellbeing
Information Summary
Risks Identified
Actions
History of mental
health problems
Current mental
health
conditions
Self harm
Needs Identified
Suicide
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 5 Coping Mechanisms, Social & Cultural Support
Information Summary
Risks Identified
Actions
Positive coping
skills
Negative
coping skills
Social Networks
Cultural Support
Needs Identified
Other areas of
life
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 6 Alcohol & Drug Use
Information Summary
Risks Identified
Actions
Drug/alcohol
abuse
Coping
mechanisms
Needs Identified
Substance
misuse services
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 7 Safeguarding
Information Summary
Risks Identified
Actions
Presence of
children/
vulnerable adults
Client concerns
Pregnant client
Involvement of
adult/children’s
services
Needs Identified
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 8 Criminal Justice System
Information Summary
Risks Identified
Actions
Reporting
Options
Support during
Investigation
Preparing for
court
Support at Court
Needs Identified
After the trial
CICA
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
D9 Employment & Education
Information Summary
Risks Identified
Actions
Employment
Status
Education Status
Employer
/Education
Provider
Awareness
Needs Identified
Special
Mitigating
Circumstances
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
D10 Finance
Information Summary
Risks Identified
Actions
Sources of
income
Welfare benefits
Debts
Financial
Assistance
Needs Identified
NRPF
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 11 Accommodation and Housing
Information Summary
Risks Identified
Actions
Adequate
Housing
Safe & Secure
Housing
Homelessness
Needs Identified
NRPF
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 12 Immigration and Residence
Information Summary
Risks Identified
Actions
Immigration
Status
Undocumented
Migrant
NRPF
Trafficking
Needs Identified
Detention
/Deportation
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 13 Risk to Professionals & Services
Information Summary
Risks Identified
Actions
Physical safety of
ISVA
Lone Working
arrangements
Other service
providers
Refusal of service
provision
Needs Identified
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk
Safety and Support (SAS) Assessment for ISVAs
Domain 14 Professional Judgement
Information Summary
Risks Identified
Actions
Any other
information
Client
perception of risk
Non-verbal
communication
Needs Identified
Gut instinct or
suspicion
Score
This template can be reproduced, edited and is available to download with the accompanying toolkit at
www.limeculture.co.uk