This section should only be completed if the referral is being made
by local authority staff
9.1 Personal welfare
Is there a concern in relation to the adult’s personal welfare? Y N
If so have you notified the Mental Welfare Commission? Y N
Please provide any details below if the concern about personal welfare directly relates to this
9.2 Adult Support & Protection (ASP)
Please confirm that you have reported the circumstances of this referral to your specialist ASP
If a referral was made what action, if any, has been taken? If you need more space to make your
comments, please use a separate sheet of paper.
9.3 Additional information
Please provide a summary of other information such as:
• Details of any other form of income known e.g. pension, benefits, allowances or income from
renting property etc.
• Details of any financial assessment carried out
• Is the adult in receipt of their personal allowance?
• Is an appointee or corporate appointee is receiving funds on behalf of the adult?
• Would the local authority be prepared to apply to be an appointee or apply for some other form
of authority e.g. guardianship?