Enclosure (1) to COMDTINST 1754.12
INITIAL RISK ASSESSMENT:
Refer to Risk Assessment Instrument for guidance.
INTERVENTION BASED ON INITIAL RISK ASSESSMENT:
FAMILY ADVOCACY CASE REVIEW COMMITTEE OPINIONS:
Give dates, place, who was present, and majority and minority opinions. Give date 5488 was sent
to command for approval and signature.
COMMAND DECISION:
Date signed 5488 is received from command and whether or not command concurs with
recommendations.
CASE STATUS:
The finding in this case of alleged (type of abuse) of (Name) by (Name and Relationship) is
substantiated. A review shows the facts, behavioral dynamics and information that support the
occurrence of abuse and/or neglect is greater and/or more likely than not than the information that
indicates abuse and/or neglect did not occur. The member was advised in writing of his or her right
of rebuttal to the commanding officer and the right of appeal to G-WPW-2 on (Date).
SERVICE PLAN:
GOAL #1:
OBJECTIVES FOR ACCOMPLISHMENT OF GOAL #1:
GOAL #2:
OBJECTIVES FOR ACCOMPLISHMENT OF GOAL #2:
THIRTY TO SIXTY DAY RISK ASSESSMENT:
REFER TO RISK ASSESSMENT INSTRUMENT.
INTERVENTION BASED ON 30 TO 60 DAY RISK ASSESSMENT:
SIGNATURE:
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