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SSF Form Translated EDIT
SSF Form Translated EDIT
Chonde gwiritsani ntchito fomu ino polemba zokhudza mlandu uliwonse wa munthu wochitiridwa nkhanza yemwe akulan
chithandizo cha SSF. Ngati muli ndi ndemanga kapena mafunso okhudza fomuyi, chonde funsani kwa Mkulu Woona za
Kalondolondo ndi Kusintha kwa Kachitidwe ka Zinthu mu Pulogalamu ya S2S (S2S Co-Lead - Monitoring, Learning and Adap
Kodi mukufuna kupitiliza?
Which WRO is the case registered with?
Please provide the Unique Identification Number recorded on the hard copy form
Are you entering data relating to a newly registered case, or a tracking data for an existing case?
Has the survivor provided their informed consent, or informed assent and parental/guardian consent for data related to th
to be entered into the S2S digital programme management system?
Date of initial contact between survivor and WRO
What is the gender of the survivor?
Is the survivor an adult or a child under 18 years of age?
Does the survivor self-identify as a person with a disability?
Was an immediate risk assessment undertaken and responded to appropriately?
Please provide details why an immediate risk assessment was not undertaken or responded to accordingly. Please include
of feedback provided to the accompanier if this was an oversight
Based on the details provided in the perpetrator form, how would you categorise the type of violence.
Has a Case Management Plan been developed with the survivor?
If no Case Management Plan has been developed, please explain why not and outline next steps for the survivor’s case
Date of initial case plan assessment
Date completing the case management plan
Where was the survivor referred to you from?
If other, please specify
You noted above that this is a case of SEAH, but you have noted that there is no plan to report to an ODA actor. Please exp
why a report will not be made.
If this is the survivor’s choice, they should not be pushed to make a report, but we would appreciate you noting this for ou
learning purposes.
You noted above that this a case of VAWG/GBV triggered by an ODA actor, but you have noted that there is no plan to rep
an ODA actor. Please explain why a report will not be made.
If this is the survivor’s choice, they should not be pushed to make a report, but we would appreciate you noting this for ou
learning purposes.
Does the case management plan include referral to hospital or other medical care?
Please provide details of the health services referred to
Amount paid for health/medical care
Does the case management plan include referral to Psychosocial Support Services?
Please provide details of the psychosocial support services referred to
Amount paid for psychosocial services
Does the case-management plan include support for the survivor’s children?
Please provide details of support for survivor children
Amount paid for support to survivor’s children
Does the case management plan include any other support details
Please provide details of other support planned for
Amount paid for other support
Has the survivor provided their informed consent, or informed assent and parental/guardian consent for data related to th
to be entered into the S2S digital programme management system?
When accompanying the survivor to access services (e.g., from police, health care providers, legal services or others), did t
accompanier have to take any action to prevent the survivor from being subjected to further risks or harm by the service p
If yes, please provide details
Since the previous report was submitted for this case, have any further funds been provided to the Accompanier?
If yes, how much additional payment has been made to the Accompanier since the previous report was submitted for this
Since the previous report was submitted for this case, has any additional payment been made to the survivor for food?
If yes, how much additional payment has been made to the survivor for food since the previous report was submitted?
Since the previous report was submitted for this case, has any further payment been made for transport for the survivor?
If yes, how much additional payment has been made to the survivor for transport since the previous report was submitted
Since the previous report was submitted for this case, has shelter been provided, or any additional payment made for the
prevision of shelter for the survivor?
If yes, was the additional shelter supported provided in-kind or in cash?
How much payment has been made to the survivor for shelter since the previous report was submitted?
Since the previous report was submitted, has any further payment been made for health services for the survivor?
How much payment has been made to the survivor for health services since the previous report was submitted?
Since the previous report was submitted, has any further payment been made for psychosocial services for the survivor?
How much payment has been made to the survivor for psychosocial services since the previous report was submitted?
Since the previous report was submitted, has any further payment been made for service provision (e.g. courts, police) for
survivor?
What was the payment for? i.e. service charge, transport for the service provider etc.?
If yes, for which service was a payment made?
How much was paid for service provision since the previous report was submitted for this case?
Since the previous report was submitted, has any further payment been made to the survivor to support their children?
If yes, how much payment has been made to the survivor for support to their children since the previous report was subm
this case?
Since the previous report was submitted, has any additional payment been made to the survivor for any other support?
If yes, how much payment has been made to the survivor for other support since the previous report was submitted?
And what was the other support that was paid for?
Has the case been closed?
If the case has been closed, was it the survivor who decided to close the case?
If yes, please provide an explanation as to why the survivor has decided to close her case for support from the WRO
If it was not the survivor who decided to close the case, why was it closed?
Do you have any concerns relating to Safeguarding abuses or potential harm caused or triggered by the S2S programme?
If yes, please provide details without recording any names or personally identifying information relating to the individuals
involved.
If you would like to report a suspect case of SEAH abuse or potential harm caused or triggered by the S2S, please refer to t
reporting mechanisms outlined in the S2S Safeguarding policy.
Is there any other information you would like to report?
If yes, please provide details of other information you would like to report
Payments made
Yes
No
New case
Tracking existing case
Female
Male
They prefer not to say
Adult (18 or over)
Child (Under 18)
VAWG/GBV unrelated to the actions of an ODA actor
VAWG/GBV triggered by an ODA actor
SEAH perpetrated by an ODA actor
Self-referral
Local Traditional Leader
Local Religious Leader
Police Victim Support Unit
Community Victim Support Unit
Social Welfare Officer
Je, mhanga ametoa idhini ya kufahamishwa kwao, au kukubaliana kwa habari na idhini ya mzazi/mlezi ili data in
Tafadhali toa maelezo kwanini tathmini ya hatari ya moja kwa moja haikufanywa au haikijibiwa ipasavyo. Tafadh
Kulingana na maelezo yaliyotolewa kwenye fomu ya mtenda makosa, utapangaje aina ya unyanyasaji?
Je, mpango wa usimamizi wa kesi umebuniwa na mhanga?
Ikiwa hakuna Mpango wa Usimamizi wa Kesi ulioundwa, tafadhali eleza kwanini na panga hatua inayofuata kwa
Tafadhali toa muhtasari mfupi wa kesi. USIWASILISHE MAJINA, MAELEZO YA MNAFASI, AU MAELEZO MEN
Uliweka hapo juu kuwa hii ni kesi ya SEAH, lakini umebaini kuwa hakuna mpango wa kuripoti kwa mwigizaji wa O
Ulizingatia hapo juu kuwa hili ni kesi ya VAWG/GBV iliyosababishwa na mhusika wa ODA, lakini umeeleza kuwa
Je, mpango wa usimamizi wa kesi unaingiza rufaa kwa hospitali au huduma nyingine za matibabu?
Tafadhali toa maelezo ya huduma za afya zilizorufiwa
Kiasi kilicholipwa kwa huduma za afya/matibabu
Je, mpango wa usimamizi wa kesi unaingiza rufaa kwa Huduma za Usaidizi wa Kiakili na Kijamii?
Tafadhali toa maelezo ya huduma za usaidizi wa kisaikolojia na kijamii zilizorufiwa
Kiasi kilicholipwa kwa huduma za kisaikolojia
Je, mpango wa usimamizi wa kesi unaingiza usaidizi kwa watoto wa manusura?
Tafadhali toa maelezo ya usaidizi kwa watoto wa manusura
Kiasi kilicholipwa kwa usaidizi kwa watoto wa manusura
Je, mpango wa usimamizi wa kesi unaingiza maelezo mengine ya usaidizi
Tafadhali toa maelezo ya usaidizi mwingine uliopangwa
Kiasi kilicholipwa kwa usaidizi mwingine
Je, manusura ametoa idhini yao iliyobainishwa, au ridhaa iliyobainishwa na idhini ya mzazi/mlezi kuhusu data ina
Tafadhali eleza hatua zilizochukuliwa, kama ilivyoelezwa katika Fomu ya Kufuatilia Kesi
Tafadhali eleza hatua za ziada au zinazoendelea zinazohitajika
Ikiwa kuna mwambatishaji aliyeelimika aliyepeanwa wakati wa mchakato wa kupanga usimamizi wa kesi, je, huy
Wakati wa kuambatana na manusura kupata huduma (k.m., polisi, watoa huduma za afya, huduma za kisheria a
Ikiwa ndio, ni kiasi gani cha malipo ya ziada kilichofanyika kwa Mwendeshaji tangu ripoti iliyopita itolewe kwa kes
Tangu ripoti iliyopita itolewe kwa kesi hii, je, kulifanyika malipo ya ziada kwa muathirika kwa ajili ya chakula?
Ikiwa ndio, ni kiasi gani cha malipo ya ziada kilichofanyika kwa muathirika kwa chakula tangu ripoti iliyopita itolew
Tangu ripoti iliyopita itolewe kwa kesi hii, je, kulifanyika malipo zaidi kwa usafiri kwa muathirika?
Ikiwa ndio, ni kiasi gani cha malipo ya ziada kilichofanyika kwa muathirika kwa usafiri tangu ripoti iliyopita itolewe
Tangu ripoti iliyopita itolewe kwa kesi hii, je, makazi yalitolewa, au kulifanyika malipo ya ziada kwa utoaji wa mak
Ikiwa ndio, je, makazi ya ziada yalitolewa kwa msaada ilitolewa kwa njia ya vitu au fedha taslimu?
Kiasi gani cha malipo kilichofanyika kwa muathirika kwa ajili ya makazi tangu ripoti iliyopita itolewe?
Tangu ripoti iliyopita itolewe, je, kumefanyika malipo zaidi kwa huduma za afya kwa muathirika?
Kiasi gani cha malipo kilichofanyika kwa muathirika kwa huduma za afya tangu ripoti iliyopita itolewe?
Tangu ripoti iliyopita itolewe, je, kumefanyika malipo zaidi kwa huduma ya ushauri wa kisaikolojia kwa muathirika
Kiasi gani cha malipo kilichofanyika kwa muathirika kwa huduma ya ushauri wa kisaikolojia tangu ripoti iliyopita it
Tangu ripoti iliyopita itolewe, je, kumefanyika malipo zaidi kwa utoaji wa huduma (k.m. mahakama, polisi) kwa m
Malipo hayo yalikuwa kwa ajili ya nini? Yaani malipo ya huduma, usafiri kwa mtoaji wa huduma nk?
Ikiwa ndio, huduma gani malipo yalifanyika?
Kiasi gani kililipwa kwa utoaji wa huduma tangu ripoti iliyopita itolewe kwa kesi hii?
Tangu ripoti iliyopita itolewe, je, kumefanyika malipo zaidi kwa muathirika kusaidia watoto wao?
Ikiwa ndio, ni kiasi gani cha malipo kilichofanyika kwa muathirika kusaidia watoto wao tangu ripoti iliyopita itolewe
Tangu ripoti iliyopita itolewe, je, kumefanyika malipo ya ziada kwa muathirika kwa msaada mwingine wowote?
Kama ndio, ni malipo kiasi gani yamefanywa kwa muathirika kwa ajili ya msaada mwingine tangu ripoti ya awali i
Ikiwa ndio, tafadhali toa maelezo kuhusu kwa nini muathirika amechagua kufunga kesi yake kwa msaada kutoka
Je, una wasiwasi wowote kuhusiana na unyanyasaji wa ulinzi au madhara yanayoweza kusababishwa au kusab
Ikiwa ndio, tafadhali toa maelezo bila kurekodi majina au habari za kibinafsi kuhusiana na watu waliohusika. Ikiw
Mwanafamilia wa Muathirika
Rafiki wa Muathirika
Nyingine
Muongoza safari hana mafunzo
Fedha
Aina ya vitu
Polisi
Mwakilishi wa Kisheria
Kiongozi wa Kijadi
Kiongozi wa Kidini
Idara ya Ustawi wa Jamii
Muathirika hana watoto
Huduma za Afya
Huduma za Kisaikolojia
inayohusiana na kesi yao ichapishwe kwenye mfumo wa usimamizi wa programu ya dijiti ya S2S
dhali jumuisha maelezo ya maoni yaliyotolewa kwa msaidizi ikiwa hii ilikuwa ni kosa
wa kesi ya mhanga
uwa hakuna mpango wa kuripoti kwa mhusika wa ODA. Tafadhali eleza kwa nini ripoti haitafanywa. Ikiwa hii ni chaguo la ma
inayohusiana na kesi yao kuingizwa kwenye mfumo wa usimamizi wa programu ya dijiti ya S2S?
a au wengine), je, mwambatishaji alilazimika kuchukua hatua yoyote ili kuzuia manusura kushuhulikiwa na hatari au madhar
akazi kwa muathirika?
muathirika?
ali iliwasilishwa?
kiwa ungependa kuripoti kesi ya shaka ya unyanyasaji wa SEAH au madhara yanayoweza kusababishwa au kusababishwa
upeleka ripoti, lakini tungetathmini ikiwa ni kwa madhumuni yetu ya kujifunza.
Ikiwa hii ni chaguo la manusura, hawapaswi kushinikizwa kutoa ripoti, lakini tungependa ueleze hili kwa madhumuni yetu ya