Form DVPP03 v3.0
Oct 2016
Notice that continued provision of non-violence
programme is inappropriate
If at any time during the provision of a non-violence programme the service provider considers that
it is no longer appropriate or practicable to provide the programme, or the client is not participating
fully, the service provider must notify the Registrar (Domestic Violence Act 1995, section 51M). If
appropriate, this form can also serve to inform the Court the provider is closing the agency referral
for this client.
Attendance directed under the Domestic
Violence Act 1995
Attendance as part of pre-sentencing in
the Criminal Court
Client name:
Court Reference No:
Gender:
Ethnicity:
Client contact details:
No of sessions
agreed:
No of sessions attended:
Date of last session
This form is being used to report to the Court on a:
Notice that continued provision is inappropriate
Notice that continued provision is inappropriate and that the agency referral is being closed
No longer appropriate or practicable
It is no longer appropriate or practicable to provide the programme to the client because:
Mental health issues to be addressed
Drug alcohol issues to be addressed
Other matters to be addressed
Change of location/circumstances
Other (give details below):
1
Inappropriate to continue: client not participating
The client is not participating fully in the programme, and this is significantly affecting their ability
to benefit fully from the programme. In my opinion:
the client would benefit from further sessions with me but only with resettled terms of
attendance
the client would benefit from a referral to a different service provider
Reasons/detail:
Programme closure information
Please complete this section only if you are also closing the agency referral for this client
The client has not achieved the objectives of the programme for the reasons detailed above,
and I am closing the agency referral for this client.
I have concerns about the safety of a protected person and a Notice of Safety Concerns
(DVPP01) accompanies this form
Service provider’s details
Organisation Name
Facilitator Name
Signature
Date
2