FORENSIC ABUSE LOG

Date of Log Entry

MM

DD

YYYY

Your Name *

First Name

Last Name

Your Phone #

(###)

###

####

Date of Incident

MM

DD

YYYY

Time of Incident

Hour

Minute

Second

AM PM

Location of Incident *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Abuser Name *

First Name

Last Name

What types of abuse were used in this incident? See link at the top for a glossary.

Physical

Psychological / Emotional

Sexual

Financial

Religious

Educational

Elders

Child

Neglect

Self-Neglect

Were there any witnesses?

Yes

No

Witness 1 Name

First Name

Last Name

Witness 1 Phone

(###)

###

####

Witness 2 Name

First Name

Last Name

Witness 2 Phone

(###)

###

####

Witness 3 Name

First Name

Last Name

Witness 3 Phone

(###)

###

####

Were there any minor children present at the time of the incident?

Yes

No

Minor Child 1 Name

First Name

Last Name

Minor Child 2 Name

First Name

Last Name

Minor Child 3 Name

First Name

Last Name

Were any children hurt during the incident?

Yes

No

Were there and Proxy Abusers (Flying Monkeys) involved in the incident (even if they were not present diring the incident?

Yes

No

Flying Monkey 1 Name

First Name

Last Name

Flying Monkey 1 Phone

(###)

###

####

Flying Monkey 2 Name

First Name

Last Name

Flying Monkey 2 Phone

(###)

###

####

Flying Monkey 3 Name

First Name

Last Name

Flying Monkey 3 Phone

(###)

###

####

Was this the first abusive incident?

Yes

No

How many abusive incident have there been in the past?

1-5

5-20

20-50

50-100

Too many to count

How often does this kind of abuse happen?

1 x year

4 x year

1 x month

1 x week

1 x day

several times a day

Are there any Ongoing Concerns? (check all that apply)

Continued Threats or Intimidation: If the perpetrator continues to threaten or intimidate the victim or other individuals involved in the case, it would be considered an ongoing concern that may require protective measures or legal intervention.

Safety Risks: Any ongoing safety risks or vulnerabilities faced by the victim, such as living in a dangerous environment or being at risk of further harm, would be considered ongoing concerns that need to be addressed.

Emotional or Psychological Impact: Ongoing emotional or psychological effects experienced by the victim as a result of the abuse, such as anxiety, depression, or trauma-related symptoms, would be considered ongoing concerns that may require therapeutic support or counseling.

Financial Exploitation: If the perpetrator continues to exploit the victim financially or attempts to control their finances, it would be considered an ongoing concern that may require financial safeguards or legal action.

Social Isolation: Ongoing social isolation or alienation experienced by the victim, such as being cut off from friends, family, or support networks, would be considered an ongoing concern that may necessitate efforts to reconnect the victim with social support systems.

Legal Proceedings: Ongoing legal proceedings related to the abuse case, such as court hearings, protective orders, or custody battles, would be considered ongoing concerns that may require ongoing documentation and support.

Child Welfare Issues: If children are involved in the abuse case, ongoing concerns related to their safety, well-being, or custody arrangements would need to be addressed and monitored.

Medical or Physical Health Needs: Ongoing medical or physical health needs resulting from the abuse, such as injuries or chronic health conditions, would be considered ongoing concerns that may require ongoing medical care or treatment.

Housing Stability: Ongoing concerns related to housing stability, such as homelessness or precarious living situations resulting from the abuse, would need to be addressed to ensure the victim’s safety and well-being.