POP Center Problems Retaliatory Violent Disputes Appendix A
Appendix A: Level 1 Dispute Assessment Form
DISPUTE VIOLENCE RISK ASSESSMENT LEVEL 1 REVIEW
Complete this form when you identify a potentially violent dispute. For additional information on the individuals/location below, call the Crime Analysis Center.
Incident Location:
Date of incident:
Case report #(s):
Retaliatory dispute definition
A violent retaliatory dispute is an interaction involving conflict, over a period of time, between two or more individuals and/or people associated with them and marked by two or more events involving confrontation or intimidation, in which at least some of those events involve violent acts or credible threats of violence.
- Provide the names of two or more individuals/groups believed to be involved in this dispute.
- Do you believe the risk of violence is? (check all that apply)
o Immediate o Ongoing o Long term
- Why do you think this will result in further violence?
- Briefly describe the way you found out about this dispute. What event or information is relevant?
- What do you believe is the cause of this dispute?
- What specific actions did you take to address this dispute?
Name of person completing this report: Date:
Supervisor review: Signature: Date:
Supervisor comments:
