KATSINA STATE MINISTRY OF BASIC AND SECONDARY EDUCATION KATSINA STATE ADOLESCENT GIRLS’ INITIATIVE FOR LEARNING AND EMPOWERMENT (AGILE) PROJECT GENDER BASED VIOLENCE ACTION PLAN RECOMMENDED FOR PREVENTION, MITIGATION AND RESPONSE TO PROJECT INDUCED GBV RISKS January 2021 1 Contents ACRONYMS ................................................................................................................................................... 3 DEFINITIONS.................................................................................................................................................. 4 1.0 OVERVIEW ............................................................................................................................................. 5 2.0 AGILE KATSINA GBV ACTION PLAN TABLE .............................................................................................. 6 3.0 ACCOUNTABILITY AND RESPONSE FRAMEWORK FOR GBV/SEA/SH PREVENTION, MITIGATION AND RESPONSE ............................................................................................................................................. 9 3.1 Introduction ........................................................................................................................................ 9 3.2 GBV Service Providers and Referral of Survivors Services .................................................................. 9 3.3 Training ............................................................................................................................................... 9 3.4 Communication ................................................................................................................................... 9 3.5 Security/Safety Measures ................................................................................................................. 10 3.6 Reporting allegation and incidents of Sexual Exploitation and Abuse ............................................ 11 3.7 Process of SEA Allegation Investigation ............................................................................................ 12 4.0 GBV SURVIVORS’ ENTRY POINT OF SERVICES AND REFERRAL PATHWAYS ........................................ 14 ANNEX ......................................................................................................................................................... 15 2 ACRONYMS GBV Gender Based Violence ESMP Environmental and Social Management Plan CSO Civil Society Organization FBO Faith Based Organization WB World Bank OSH Occupational Health and Safety GRM Grievance Redress Mechanism GRC Grievance Redress Committee SEA Sexual Exploitation and Abuse SH Sexual Harassment NGO Non-Governmental Organization SPIU State Project Implementing Unit IA Implementing Agency SSO Social Safeguard Officer CoC Codes of Conduct E and S Environmental and Social ARF Accountability and Response Framework WASH Water, Sanitation and Hygiene 3 DEFINITIONS Gender-based violence (GBV) is an umbrella term for any harmful act that is perpetrated against a person’s will and that is based on socially ascribed (i.e., gender) differences between males and females. It includes acts that inflict physical, sexual or mental harm or suffering, threats of such acts, coercion, and other deprivations of liberty. These acts can occur in public or in private GBV SERVICE PROVIDERS: An organization offering specific services for GBV survivors, such as health services, psychosocial support, shelter, legal aid, safety/security services, etc. Sexual Exploitation and Abuse (SEA): any actual or attempted abuse of a position of vulnerability, differential power or trust for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another. Sexual Harassment (SH): Any unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature. GBV ACTION PLAN: Document which outlines how the project will put in place the necessary protocols and mechanisms to address SEA/SH risks; and how to address any SEA/SH allegations that may arise. ENVIRONMENTAL AND SOCIAL ASSESSMENT (ESA) identifies potential environmental and social impacts early on in project preparation and is usually the primary vehicle for assessing SEA/SH risks on an IPF involving major civil works. ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN (ESMP) will then define the specific ways that SEA/SH risks are to be addressed in the project by identifying prevention and mitigation measures, including the development of a SEA/SH Prevention and Response Action Plan. ACCOUNTABILITY AND RESPONSE FRAMEWORK details how allegations of SEA/SH will be handled (investigation procedures) and disciplinary action for violation of the CoC by workers. REFERRAL PATHWAY: A link that connects GBV service providers. GRIEVANCE REDRESS MECHANISM A mechanism with multiple channels for reporting complaints associated with the project 4 1.0 OVERVIEW In August 2017, a set of recommended steps was developed and released by the global Gender Based Violence Task Force to strengthen the World Bank’s capacity to identify, prevent, mitigate, and respond to risks of all forms of GBV. The implementation of the recommended steps and measures help to prevent and respond to incidents of sexual exploitation and abuse (SEA) and all forms of GBV that occur in Bank financed projects. The development of an action plan is to implement the recommended steps advised by the Task Force Team of the Bank. Focusing and implementing the steps outlined in the action plan ensures full dynamic engagement and participation of the community partners and beneficiaries as well as the protection and security of all women, children and vulnerable groups. Some of the potential project induced GBV risks identified in Katsina State during the AGILE project’s Environmental and Social field assessments include: • Labour influx of project workers may introduce or exacerbate SEA/SH/GBV risks and risks of STIs/STDs for community members, students and staff. Influx of Camp Followers could also increase the presence of sex workers in the communities. School girls/ Female school staff/Teenage and Adolescent Females in the community are at potential risks of SEA/SH issues are at risks of contracting STIs, STDs or unwanted and/or early pregnancies due to association with migrant workers/contractors of the project. The influx of workers may also lead to increase in the presence of sex workers and transactional sex. • In the School premises, Students may be exposed to sexual exploitation in the form of sex for grade • Women and Children who reside or offer petty trading services within project communities. They could be faced with the need to engage in activities such as petty trading and hawking, and may be at risk to SH and SEA from project workers. Women may also be exposed to sexual exploitation in exchange for jobs at the project work sites. • Sourcing for unskilled labour may lead to risks of child labour and increase dropout during construction activities. This could further predispose children to health & safety risks, Violence Against Children (VAC) etc • Elderly (>60years)/Physically Challenged/Widows: these may experience greater difficulty in navigating their way if there are restrictions to access during the construction phase of the project. They may be confined to a location until the road is reopened. Furthermore, they may be at more risk from dust, emissions and excessive noise during the project construction phase. Persons with Disabilities (PWDs) may also be excluded from accessing the benefits of the project either by discrimination as workforce or unable to use the newly constructed facilities that are not inclusive. In order to prevent and mitigate these potential SEA/SH/GBV risks highlighted above, the table below outlines the recommended actions to be undertaken by the Katsina AGILE project. 5 2.0 AGILE KATSINA GBV ACTION PLAN TABLE This table consists of recommended actions to address project induced SEA/SH risks. KEY ACTIONS OBJECTIVE TIMELINE FOR ACTION RESPONSIBLE UNIT Sensitization of the SPIU and To build the knowledge of Jan 2023 GBV officer/GBV specialist IA on the SEA/SH risks, codes the importance on of conduct, GRM and referral addressing GBV/SEA/SH mechanisms for survivors risks on the project and refer survivors to the appropriate services available Stakeholder’s Consultation To keep them abreast on Jan 2023 SPIU with SMBCs, Religious project activities, May 2023 leaders, Traditional Rulers, mechanisms in place by Sept 2023 School Managers, etc the project to prevent Nov 2023 and respond to The SEA/SH related issues in GBV/SEA/SH risks (GRM, the SEP of the project will be GBV Service providers, addressed CoC signed by workers, referral pathways available to survivors) To disclose this information to the community Mapping of GBV service To identify and establish a Feb 2023 GBV officer/GBV specialist providers in the 17 local referral system through governments throughout the which survivors of GBV state can seek help in a timely and appropriate manner Validation of the service providers identified Capacity building of the Feb 2023 identified service providers on response to GBV and case management Establishment of Katsina Feb 2023 to April 2023 State’s referral directory, manuals and posters Review and update all To ensure that SEA/SH Mar 2023 GBV Officer/GBV safeguard documents (ESMP, risks and measures to Will be an ongoing process before and Specialist/SSO ESMF, C-ESMP, etc) address them are after the commencement of civil adequately reflected in works these documents and updated as risks situation changes 6 KEY ACTIONS OBJECTIVE TIMELINE FOR ACTION RESPONSIBLE UNIT Development of SEA/SH To capture details on how Jan 2023 GBV Officer/GBV Specialist Action Plan and SEA/SH on a project will Accountability and Response be handled and To be reviewed prior to Framework disciplinary measures for commencement of civil works workers who violate the CoC Review the SPIU’s /IA’s To assess their Apr 2023 GBV Officer/GBV Specialist capacity to respond SEA/SH understanding on addressing and Will be reviewed prior to responding to SEA/SH commencement of civil works Operationalization of the To receive and address May 2023 SPIU/GRM Officer/GRC project GRM with multiple project complaints and reporting channels. Specific SEA/SH complaints To be checked and updated upon procedures on handling and commencement of civil works receiving SEA/SH complaints should be factored in. Engagement of a GBV To provide support Dec 2022 SPIU Specialist towards preventing GBV on the project Engagement of a To supervise issues Dec 2022 SPIU social/environmental related to SEA/SH (e.g. specialist in the supervising supervise signing of CoCs, Engineer’s team with GBV verify working GM for specific skills SEA/SH is in place, refer cases where needed). Will also work with GBV service providers as entry points into service provision to raise awareness of the GM. Review of the GRM’s To ensure that the Prior to commencement of civil works GRM Team/SPIU reception and processing of protocols are duly complaints followed in referring complaints to a specific established mechanism for reviewing and addressing SEA/SH complaints in a timely manner 7 KEY ACTIONS OBJECTIVE TIMELINE FOR ACTION RESPONSIBLE UNIT Codes of Conduct Trainings To ensure that the Mar 2023 SPIU/GBV Officer/GBV and Signing by workers and requirements in CoCs are Specialist/E and S team teachers (CoC will be clearly understood by the A second training for project workers translated to the local workers signing. will be conducted upon language for easily implementation understanding) Workshop for project To disclose to the local Mar2023 to Sept 2023 SPIU/GBV Officer/GBV workers, students, teachers, community and Specialist and local community on participants the SEA/SH. mechanisms in place to Have project workers and prevent, address and local community undergo respond to SEA/SH training on SEA/SH, CoC signed by the workers, GRM, GBV service providers, how to use the referral directory, etc Establishment of separate, To prevent and reduce SPIU/GBV Officer/GBV safe and easily accessible risks of SEA/SH Specialist/SS team facilities for women and men working on the site. Ensure public spaces around the project grounds are well- lit. Visibly display signs of To prevent and reduce Dec 2024 SPIU/GBV Officer/GBV prohibition of SEA/SH around risks of SEA/SH Specialist/SS the project sites to serve as a team/Supervision reminder for workers and the Engineer community (will be translated in the local language) Regular Monitoring and To ensure that all ESA/SH Quarterly SPIU/GRM Officer/GBV Evaluation of SEA/SH prevention and response Officer prevention and response mechanisms are effective activities and functional Outreach campaigns in AGILE To promote the AGILE Mar 2023 to Nov 2023 SPIU/GBV Officer/GBV Schools on Menstrual Project objectives Specialist Hygiene, WASH, Financial responsibility, Zero tolerance to GBV, SDGs, Climate Change 8 3.0 ACCOUNTABILITY AND RESPONSE FRAMEWORK FOR GBV/SEA/SH PREVENTION, MITIGATION AND RESPONSE 3.1 Introduction Without the full participation of men, women, boys and girls, no community, country, or economy can achieve its full potential or combat the challenges of the 21st century. Therefore, the World Bank is committed to bridging these gaps by tackling poverty and promoting sustainable economic growth beneficial to all (World Bank,2018). Due to the negative manifestations and outcomes GBV, SEA/ SH such as rejection, stigma, and chronic health and emotional damage on survivors, it is very important for the survivors to have free and easy access to medical, psychosocial and justice services. In some cases, shame and blaming of survivors tend to promote silence culture rather than reporting the incident or approach the project directly to lay complains. To avoid inconsistences in the number of reported cases of SEA/SH, specific procedures must be put in place to address GBV complains. These procedures would be carried out under the guiding principles for safe and ethical handling of SEA/SH allegations through recommended steps, provision of technical capacity using specialized trainings and protocols that will enable them to interact with survivors, adopting the survivors centered approach in implementing the protocols or using NGOs qualified in handling SEA/SH complains. 3.2 GBV Service Providers and Referral of Survivors Services In order to respond to GBV complaints appropriately due to complex nature of GBV (should be done in a confidential, dignified and respectful manner), a mapping of service provider is necessary to identify and ascertain the types, quality and accessibility of services they provide. Identification of these service providers aids the effective functionality of the GRM as service providers need to be identified for easy referral of GBV survivors. GBV Focal persons need to be identified and trained on how to receive, document, provide psychosocial first aid support to the survivors and make timely referral to GBV service providers based on the need and wish of the GBV survivors. The GBV focal person is expected to liaise with GRCs to follow-up on cases to ensure that procedures are properly and thoroughly followed and involve the right personnel e.g., state security and legal aid agencies in the case of legal prosecution. 3.3 Training Due to the sensitivity of GBV incidents, all GBV cases must be handled with utmost confidentiality and care therefore, all Officers involved in handling SEA/SH and GRM are to be trained on how to provide support and interact with survivors. These trainings will be conducted by the GBV officer supported by specialized NGOs partners. 3.4 Communication It is important to provide the necessary information needed by survivors on how and where to go to for help in the event of an assault (sexually or physically). Survivors must be made to understand the functionality of the services they will be provided with. The survivor should be provided with an honest and complete information about referral services available. The survivor must be fully informed of the involvement of the law and the survivor must give his/her consent before the involvement of any third party in the case (where applicable, in the cases of children, reporting is mandatory). 9 3.5 Security/Safety Measures Some security and safety measures need to be put in schools and around the communities in order to prevent GBV/SEA/SH incidences e.g. 1. Location of restrooms within the schools must be secure and gendered. 2. Impacting youth with the knowledge of the negative effect of GBV through behavioural change campaign. 3. Ensure the signing of schools COC by both students and teachers. 4. All GBV actors e.g., GBV/GRM officers, GBV focal persons, GBV service providers, legal aids agencies and state security agencies must work as a team and abide by the guiding principles for safe ethical handling of GBV using the recommended steps provided. 10 3.6 Reporting allegation and incidents of Sexual Exploitation and Abuse SEA reporting procedure (Complain Mechanism) ➢ Survivor self-report and incident of sexual exploitation and abuse (SEA) focal point of the GRC ➢ Survivor tells someone he/ she trusts, and the person makes a formal complain of SEA to GRCs Channels for reporting SEA ➢ Complain boxes ➢ Safe spaces ➢ Protection complaint desks (GRCs) ➢ Health facilities Response form for the recipient of complaint Report the complaint confidently (within 24 hours) to -: ➢ Provision of safe and confidential environment (safe space ) ➢ GBV focal person ➢ Conduct immediate safe and PSS needs assessments ➢ GRCs ➢ Refer survivor/complainant to service provider using ➢ GBV/GRM officers GBV referral pathway for medical, PSS and case ➢ State Securities management using the LASC SEA and referral form, ➢ NPC/NPCU record only necessary information ➢ Protect the form, do not establish whether or not the allegation is true or try to make any investigation into the allegation If complaint involves a If complaint involves a construction member of the community, worker, refer to inform the complainant of ➢ GBV focal person available option (police) if If the complaint involves a staff member, to ➢ GBV/GRM officer survivor is interested. ➢ Contractor for action ➢ GBV/GRM officer ➢ PC for action ➢ PC for action ➢ State Securities 11 3.7 Process of SEA Allegation Investigation If the report about SEA allegation is coming from someone ▪ The person concerned (survivor) will be invited for questioning by the focal person who will probe saying “hello, I know you are a beneficiary of AGILE project, what is the working relationship between you and Mr.----------------- ?(the accused)” this will make you hear from him or her to find out about the person from the survivor and the relationship that exist between them. ▪ You check for the survivor’s friend or colleague and invite him/ her to her more about the relationship that exist between the survivor and person being accused. ▪ After hearing the two side of the story, then you invited the person being accused to inform him or her of the allegation and should be given an opportunity to answer the allegation in writing and if he denies then you present the evidence of the investigation to him/ her. ▪ If the allegation is confirmed to be true, the accused person should face proper legal proceedings by engaging the security agencies for further action. ▪ You then write the report of the investigation and present to the GR Committee for disciplinary action in line with AGILE project CoC. if the perpetrators are a staff, he will be referred to the PC, if a construction worker, he will be referred to the contractor, if he is a member of the community he will be referred to the police for the necessary action to ensure that the survivor is fully aware that he/she has control on how information about his/her cases shared with other agency or individuals, If the report about the allegation is coming from the survivor 1. You invite her friend or colleague(s) by asking about the relation between the accused and complainant to hear about allegation. 2. You may obtain written consent from the complainant regarding the information that will be made viable to others within the complaint manager system. 3. You then invite the accused to inform him or her of the allegation and his or she should be given an opportunity to answer the allegation if he/she denies then you present the evidence of the investigation to him or her. 4. You write the report of the investigation and submit to the GR Committee for disciplinary action based on AGILE Project Code of Conduct (CoC). Process of handling GBV Cases In the event where an incident of GBV is reported to the GRC, the case should be referred to the GBV focal person who act as the Case worker to provide first aid psychosocial support (PSS) will be document him or her and to refer him or her (the survivor) to the relevant service provider based on his or her need as outlined in the Referral pathway below. While the survivor is accessing the needed services, the GBV focal person follows up with the survivor to ensure survivor service from referral stage up to the point closure and is satisfied. Response service should be based on the survivor centered approach (according to the wish and need of the survivor), where the survivor chooses what services he or she wants to access at his or her discretion, with no compulsion. Where the survivor declines access to service, don’t force him or her, rather you inform her of the consequences of not accessing the service and allow him or her to decide. 12 The Focal persons should also ensure proper legal measures are taken against the perpetrators, by engaging the security agencies to ensure proper action and discipline is taken. 13 4.0 GBV SURVIVORS’ ENTRY POINT OF SERVICES AND REFERRAL PATHWAYS SURVIVOR OF GENDER BASED VIOLENCE GBV focal Persons /Counsellors / Social workers and health workers / security agencies / legal aids agencies Clinical Services ➢ medical services e.g primary Health centers Non-Clinical/Security Services ➢ psychosocial support ➢ Safety and security e.g., counselling e.g police ➢ Legal services e.g legal aid group/NGOs ➢ Social welfare e.g GBV Shelters Case Managers GBV/GRM and Health officers For Documentation and Recommendation 14 ANNEX INSTRUCTIONS 1- This form must be filled out by the person providing services to the client. 2- Remind your client that all information will be kept confidential, and that they may choose not to answer any of the following questions. Report Date* Incident Date* Report by Survivor*?  Yes No Survivor Information Survivor’s Sex* Country of Origin*? Specific Needs / Vulnerabilities* (check all that apply) Age*  Female  No  Unaccompanied Minor  Male  Physical Disability  Separated Child  Mental Disability  Other Vulnerable Child Details of the Incident State Name of School LGA Type of incident/violence* 1. Did the reported incident involve penetration? If yes → classify the incident as “Rape”. (Please select only ONE of the below) If no → proceed to the next incident type on the list.  Sexual Exploitation 2. Did the reported incident involve unwanted sexual contact? (Includes request for sex for grades, admission, etc) If yes → classify the incident as “Sexual Assault”.  Sexual Assault /Abuse If no → proceed to the next incident type on the list. (Includes attempted rape and all sexual violence/abuse 3. Did the reported incident involve physical assault? without penetration, and female genital mutilation) If yes → classify the incident as “Physical Assault”.  Physical Assault If no → proceed to the next incident type on the list. (Includes hitting, slapping, kicking, shoving, etc. that on the list. are not sexual in nature) 4. Did the reported incident involve psychological/emotional abuse?  Sexual Harassment and Psychological Abuse If yes → classify the incident as “Sexual Harassment and Psychological Abuse”. (Includes: threats of physical or sexual violence, forced isolation, harassment /intimidation, gestures If no → proceed to the next incident type on the list. or written words of a sexual/menacing nature, etc.) 5. Is the reported incident a case of GBV? If yes → Start over at number 1 and try again to reclassify the incident (If  Non-GBV (specify) __________________________ you have tried to classify the incident multiple times, ask your ____________________________________________ supervisor to help you classify this incident). If no → classify the incident as “non-GBV” 15 Was this incident a Harmful Traditional Practice*?  No Type of practice 1 Type of practice 2 Type of practice 3 Type of practice 4 Type of practice 5 Was money, goods, benefits, and / or services exchanged in relation to this incident*?  No  Yes Has the survivor reported this incident anywhere else* (If yes, select the type of service provider and write the name of the provider where the client reported).  No  Yes (specify) Has the survivor had any previous incidents of GBV perpetrated against them? *  No  Yes If yes, include a brief description: Alleged Perpetrator Information Number of alleged Alleged Alleged perpetrator relationship with survivor * perpetrator(s)* perpetrator sex*  Intimate partner / Former partner  Schoolmate 1  Male  Primary caregiver  Family Friend / Neighbor 2  Female  Family other than spouse or caregiver  Community member 3  Both  Supervisor / Employer  Project worker  More than 3 Age*  School teacher  No relation  Unknown  Adult  Minor  Service Provider  Unknown  Adult &Minor Main occupation of alleged perpetrator *  Community member  Police  Solider  Construction worker  Project staff  School Staff  Religious / Community Leader  Other / Unknown  Unemployed Planned Action / Action Taken: Any action / activity regarding this report Who referred this surivor to you? *  Police  Self-Referred  School Counselor  Health/Medical Services  Psychosocial/Counseling Services  Other (specify)  Local NGO/CBO  Community or Women Leader  Legal Services  School Staff/Teacher  Religious Leader client referred to medical services? * Referral Details: Was  Yes  No - Service provided by you 16 Assessment Points Describe the survivor’s emotional state at the beginning of the interview:  Scared / Fearful  Sad / Depressed  Anxious / Nervous  Angry  Calm  Other: Describe the survivor’s emotional state at the end of the interview:  Calmer than at the start of interview  Similar to that at the start of interview  More upset than at the start of interview  Other What actions were taken to ensure client’s safety? Will the survivor be safe when she or he leaves?  Safety Plan Created  Referral to Community-Based  Yes  No If no why not: Support  Referral to Safe House  Service provider to follow-up  Other Action Taken: If raped, have you explained possible consequences of rape to the survivor (& guardian if survivor is under 14)? Yes No Did the survivor give their consent to share their non-identifiable in your reports? *  Yes  No  No - Service received prior to this visit  No - Service not applicable  No - Referral declined by survivor  No - Service unavailable Was client referred to psychosocial services? * Referral Details:  Yes  No - Service provided by you  No - Service received prior to this visit  No - Service not applicable  No - Referral declined by survivor  No - Service unavailable Was client referred to a security services? * Referral Details:  Yes  No - Service provided by you  No - Service received prior to this visit  No - Service not applicable  No - Referral declined by survivor  No - Service unavailable 17 CASE FOLLOW-UPFORM PROGRESS TOWARDS GOALS Evaluate progress made towards Not Met Met Explain action/goals agreed on in the Case Action Plan Form Safety Health Care 18 Psychosocial Support Access to Justice Other (list other goals made here) Other Observations/Caseworker notes 19 RE-ASSESSING SAFETY Additional Intervention Y N Explain Planned Are there new or continued risks of danger at home? Are there any new or ongoing safety issues the survivor is facing in the community? FINAL ASSESSMENT Additional Interventions Y N Explain Planned A. Safety situation is stable Survivor is physically safe, and/or has a plan to keep physically safe B. Health situation is stable Survivor has no medical problems that require treatment C. Psychosocial wellbeing has improved Survivor is engaging in regular behavior, has a safe person to talk to D. Access to Justice secured (if applicable) E. Other Intervention Needed Follow up meeting is scheduled for (date/time/location): 20 CONFIDENTIAL CONSENT TO RECIEVE SERVICES The purpose of this form is to document a conversation between the caseworker and the survivor during the initial meeting about your organization’s case management services, confidentiality and exceptions to confidentiality, and the survivor’s rights. This form should be stored in a separate file from the casefile. I, ___________________________, hereby give permission to receive GBV services according to the following: My service provider’s primary purpose is to promote my safety, dignity, and well-being according to my wishes. She/he understands that only I fully know my own situation. Therefore, I will guide the process of identifying my needs, goals, and what I would like help with. I have the right to decide what information I wish to share with my service provider. She/he will never pressure me to share any information which I do not wish to share. If I am dissatisfied with the services I am receiving, I have the right to discuss any concerns with my service provider or their staff or to discontinue services at any time. My service provider will not refer me to any other service without first explaining the purpose of the referral, the way it would be made, and the expected consequences, and receiving my consent. At my request, my service provider may accompany me to meet with the referred agency. My name and information about my case will be kept confidential. He/She will not share this information with anyone, with the following exceptions: 1. My service provider may seek guidance from a supervisor in relation to my case. He/She would only share information as needed to support me and it will not include information that could identify me. 2. If I express thoughts or plans of committing physical harm to myself or others, He/She will take action to protect my safety and the safety of those around me. This action may include speaking with others in my community about my situation. If there is a risk of immediate danger, my service provider would not need to seek my consent in such cases but would do her/his best to inform me of actions taken. Signature/Thumbprint of client: (or parent/guardian if client is under 18) _____________________________________________________ Service providerCode:______________________________ Date:________ 21 CASE CLOSURE FORM Survivor Code: Case Opening Date: Caseworker Code: Case Closure Date CASE CLOSURE Summarize the reasons why the case is being closed. Comment on the progress made toward goals in the action plan. Where necessary, include provisions for continued services, listing agencies and contact persons. CASE CLOSURE CHECKLIST Safety plan has been reviewed and is in place. YES______ NO (explain)______ Person has been informed she or he can resume services at anytime. YES______ NO (explain)______ Case supervisor has reviewed case closure/exit plan. YES______ NO (explain)______ Explanation notes here: Service provider’s Signature/Date: _____________________________________________________ Supervisor Signature/Date: _____________________________________________________ 22 23