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Proceed to Question 9
Does the respondent have access to any weapons? No Yes
State the number, type of weapon/s and all possible locations of the weapon
Did the respondent use, or threaten to use, a weapon or another thing used as a weapon, during any incident of domestic violence?
No Yes Provide details
Has the respondent been issued with a weapons or firearms licence? No Yes
If the respondent has access to any weapons at their place of residence, please provide details
Proceed to Question 10
10. Details of any other orders
Has a court made any other order or are there other court proceedings that involve the aggrieved and the respondent? Please attach copies
Childrens Court orders Yes No
Queensland Domestic Violence Order Yes No
Police Protection Notice Yes No
Voluntary Intervention Order Yes No
Interstate Domestic Violence Order (including New Zealand) Yes No
Family Court Orders Yes No
Other relevant court order Yes No
Is there a current Protection Order application that has not been decided by the court? No Yes Attach a copy of the application
Proceed to Question 11
11. Conditions sought in the order
A court making a domestic violence order must impose a condition that the respondent –
Be of good behaviour towards the aggrieved and not commit domestic violence against the aggrieved.
If the order includes a named person who is an adult-
Be of good behaviour towards the named person and not commit associated domestic violence against the named person.
If the order includes a named person who is a child -
Be of good behaviour towards the child and not commit associated domestic violence against the child and not expose the child to domestic
A court may also impose any other condition that the court considers necessary in the circumstances and desirable in the interests of the
aggrieved, any named person or the respondent.
Do you want the court to consider any other conditions for inclusion in the protection order?
No Go to Q12 Yes Please indicate below
A) Do you want the respondent to leave specified premises? No Yes
If yes, state address of premises and provide reasons:
Domestic and Family Violence Protection Act 2012
Form DV1 – version 3 – 25 November 2017