CONFIDENTIAL WHEN COMPLETE
Please tick to confirm that the parent/guardian have agreed to have their details passed to CDDFRS
Organisation name & address:
Contact email and phone number
Are any other agencies involved
with the fire setter?
If yes, please give details:
1) What does the referrer want from this Intervention? Aims MUST be clearly stated.
2) Please describe the risk of harm to self and others (including fire service personnel) of the young person.
3) Does the young person have any mental health conditions? If so, please provide full details about all
agencies currently working with the young person.
4) Is the young person already in the criminal justice system and/or have on-going criminal proceedings?
Once this form is complete, please send to Community Risk Management:
firstname.lastname@example.org For assistance in completing, telephone: 0845 223 4221