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Guidance notes: National referral form for potential adult victims of trafficking
This form should only be completed for adults when a member of staff from a designated frontline organisation (known as a first responder) suspects someone is a victim of trafficking.
It is for use by all such agencies to record their encounters with potential victims of trafficking. It is not to be used as an interview record but as a means for a first responder to provide as much information as possible to the national referral mechanism’s trained specialists (known as competent authorities) to enable a decision to be reached on whether the subject has reasonable grounds for being treated as a victim of trafficking and to assist with the combating of trafficking.
Although this is not an interview record this does not prevent the first responder from approaching the potential victim to obtain further details where appropriate. The tick box sections (B to E) have been designed to save the first responder time in completing the form by providing recognised indicators which can be marked quickly and expanded upon in section F.
Section A

Complete as many of these as possible, as more information will help the competent authorities with their investigations.


Potential victim’s details: Items marked with an asterix should be supported by documentary evidence, where available.
Age disputed cases: When the age of the victim is uncertain and there are reasons to believe that the victim is a child, he or she shall be presumed to be a child and shall be accorded child protection measures pending verification of his or her age. Therefore, where there is concern that a young person who claims to be an adult is in fact under the age of 18 years, the young person must be treated as a child and the first responder should use the child referral form.
Any other reference numbers: Include any other reference numbers that are thought to be relevant here, for example: National insurance number, local authority or HSC reference numbers, police reference numbers, your organisation’s reference number. This will help where the competent authority needs to make further enquiries regarding the potential victim.
UK port of entry: Provide as much detail as possible as this will help us to understand how victims are being brought to the UK. Remember to indicate whether this can be substantiated (for example where the victim has been encountered at a port) or if this is based on the individual’s own statement.
Method of entry to UK: Methods of entry may include clandestine (concealed within a commercial or private vehicle), overt supported by false, forged or counterfeit identity and travel documents, or legal entry, for example on a genuine passport and visa or as a result of European Economic Area (EEA) nationality status.
Carrier: Where known please indicate the name of the commercial carrier the potential victim was travelling on (the airline, rail operator or ferry company) or the mode of transport used to enter the UK (air, rail, ferry, car, lorry).
N.B port of entry, method of entry and carrier may not be applicable if the person is a potential victim of internal trafficking.
Safe telephone number or other means of contacting: If support is required the support provider will need to know how they can contact the individual. Please indicate here if contact can only be made through you or another organisation.
UK current address: The home address may differ from the address at which the PVoT is encountered. Please indicate whether it’s safe to send trafficking related correspondence to this address. If it is not, please provide an alternative address for communication (for example the solicitors or support provider)
Contact details of person making referral: The first responder should provide their work-related details here so the case can be discussed and the results of their referral fed back.
Consent of individual to the referral: The potential victim must give their consent to this form being submitted to the national referral mechanism, if they do not sign here then the case will not be allocated to a competent authority for consideration.
Request for support: The potential victim should sign here if they want their details to be passed to the Salvation Army in England and Wales, Trafficking Awareness Raising Alliance (TARA) or Migrant Helpline in Scotland, or Migrant Helpline in Northern Ireland for the purposes of arranging accommodation and/or support. As a minimum, the first responder must ensure the potential victim understands that The Salvation Army, TARA and Migrant Helpline are able to offer support that may include safe accommodation and access to a range of support services tailored to their individual needs, for example counselling, for the duration of the ‘recovery and reflection’ period. The use of an interpreter should be considered where necessary to ensure information is provided to the potential victim in a language they understand.
A referral to the national referral mechanism will not automatically be treated as a request for support. It is the responsibility of the first responder to ensure all requests for support, ideally whilst the potential victim is present, are made in England and Wales to the Salvation Army via their 24 hour Referral Line: 0300 303 8151


  • In Scotland local arrangements with TARA 0141 2767729 and 0141 2767730 or Migrant Helpline 07837 937737 and 07789 791 110 should be followed

  • In Northern Ireland local arrangements with Migrant Helpline 013 0420 3977 and 07766 668 781 should be followed


Section B

To assist the first responder in making a primary assessment of whether the individual they have encountered is or may be a potential victim, there are 20 general indicators listed. These indicators are not a definitive list and there are many other indicators that may raise concerns, therefore the option to highlight ‘other’ indicators has been included. These indicators will work in combination with those in sections C, D and E to provide a fuller picture of the person’s circumstances. It is not the case that by selecting a set number of indicators this will equate to a person being a victim; it could be just one or a combination of factors that demonstrates that the person may be a victim, each case should be considered on its own merits. Tick all relevant boxes and provide supporting evidence in section F. After completing this section, proceed to section C.


Sections C, D and E

These sections list some of the common indicators of forced labour, domestic servitude and sexual exploitation; these will work in conjunction with the indicators already highlighted in section B. In each section tick any relevant boxes and provide supporting evidence in section F.


You may also wish to consider whether the individual:


  • mentions that they was deceived by an agent or trafficker, for example false promises given such as well paid work, marriage or access to the education system

  • mentions how they was recruited, for example after responding to an advert, by their boyfriend or a family friend or through agents

Tick all relevant boxes and provide supporting evidence in section F.


Section F

The first responder should begin by providing full details of the encounter, particularly when the trafficking issue was identified for example during a police operation, a formal interview, during a risk assessment, an enforcement raid or an asylum interview. This section also allows the first responder to expand upon any indicators that have been highlighted in Sections B to E along with the particular circumstances that the potential victim was encountered, such as their appearance, demeanour or the condition of their surrounding environment. Where a tick box has been checked in sections B to E, the comment in section F should show which section and indicator it relates to. Section F should also be used to confirm if the first responder has personally identified the indicators recorded or if they were passed to the first responder by another source (if the latter please confirm the source). Note that if any other documentation has been completed separately which the first responder believes to have relevance to the trafficking issue, the first responder should make sure it is attached as this may assist the competent authority in reaching a decision.


Where to send this form

Completed forms should be sent to the UK Human Trafficking Centre (UKHTC) via email at UKHTC@soca.x.gsi.gov.uk or by fax to 0870 496 5534.



National referral mechanism for potential adult victims of trafficking


Section A: personal details
*Last name: ………..………….…………………………………… *First name(s): ………..………….………………..........................
Also known as: ………………………...……………………………………….…………………………………………………………......
*D.O.B: ……/......../…….. Age: ……… Sex: ……………………... Place of birth: ……………………………….................................
*Nationality: ………...………………………………………….…... Language(s) spoken: ……………………………………...............
Any English spoken: Y or N Interpreter needed: Y or N Immigration status: ………………………………………….....
Other communication aids required (for example sign language): Y or N Details: ……………..……………….…………………...
Home Office reference: ………………………………………UK visa or work permit reference: ……............................................
Any other reference numbers: …………...…………………………………………………………………………………………..…….
UK port of entry …………………………………………………................................... known or claimed (delete as appropriate)
Method of entry to UK ……………………………………………… Carrier: ………………………………………………….................
Safe telephone number on which to contact the potential victim, such as a personal mobile number: ….………………………..
Other means of contacting the potential victim .….………………………….....................................................................................
UK current address.........................................................................................................................................................................
Can address be used for correspondence relating to victim identification and support? Y or N (delete as appropriate)
If not, please provide an alternative address for postal communications ......................................................................................
.........................................................................................................................................................................................................

Contact details of person making referral (first responder)
Name: ………………………………………………………………………………………………………………………………………....
Job title: ....…………………………………………………………………………………………………………………………………….
Organisation: ..…………………………………………………………………… Unit or area..............................................................
Tel: ………………………………………………………………… Mobile: ……………..………………………………………………...
Email: …………………………………………………………………………………………………………………………………….…....
Signature: ……………………………………………………………………………........................................Date: ……/......../……....

Details of encounter
Date: ……/......../……... Where was the victim encountered (provide address if different from above) ..........................................
.........................................................................................................................................................................................................


Consent of individual
Consent to the referral (mandatory)

I consent to my details including name and date of birth being submitted to the competent authority to assist in the identification process.


Signed: ……………………………………………………………………………………………...…………… Date: ……/......../……....
Request for support (optional)
I also confirm my details, including name, date of birth and contact details, may be passed to the Salvation Army in England and Wales, Trafficking Awareness Raising Alliance (TARA) or Migrant Helpline in Scotland or Migrant Helpline in Northern Ireland for the purpose of assessing my supports needs.
Signed: ……………………………………………………………………………………………...…………… Date: ……/......../……....



Section B: general indicators
Please tick all relevant boxes


  1. Distrustful of authorities




  1. Expression of fear or anxiety




  1. Signs of psychological trauma (including post traumatic stress disorder)




  1. The person acts as if instructed by another




  1. Injuries apparently a result of assault or controlling measures




  1. Evidence of control over movement, either as an individual or as a group




  1. Found in or connected to a type of location likely to be used for exploitation




  1. Restriction of movement and confinement to the workplace or to a limited area




  1. Passport or documents held by someone else




  1. Lack of access to medical care




  1. Limited social contact




  1. Limited contact with family




  1. Doesn’t know home or work address




  1. Perception of being bonded by debt




  1. Money is deducted from salary for food or accommodation




  1. Threat of being handed over to authorities




  1. Threats against the individual or their family members




  1. Being placed in a dependency situation




  1. No or limited access to bathroom or hygiene facilities




  1. Any other, please provide details in section F


Where indicators are identified record full details in section F



Section C: Indicators of forced labour
Are any of these indicators present? (tick as applicable)
Yes  please tick all relevant boxes in section C

No  continue to section D


  1. Employer or manager unable to produce documents required when employing migrant labour




  1. Employer or manager unable to provide record of wages paid to workers




  1. Poor or non existent health and safety equipment or no health and safety notices




  1. Any other evidence of labour laws being breached




  1. No or limited access to earnings or labour contract




  1. Excessive wage reductions




  1. Dependence on employer for a number of services for example work, transport and accommodation




  1. Any evidence workers are required to pay for tools, food or accommodation via deductions from their pay




  1. Imposed place of accommodation




  1. Any other, please provide details in section F


Where indicators are identified record full details in section F



Section D: Indicators of domestic servitude
Are any of these indicators present? (tick as applicable)

Yes  please tick all relevant boxes in section D

No  continue to section E


  1. Living with and working for a family in a private home




  1. Not eating with the rest of the family or being given only leftovers to eat




  1. No proper sleeping place or sleeping in shared space for example the living room




  1. No private space




  1. Forced to work in excess of normal working hours or being ‘on-call’ 24 hours per day




  1. Employer reports them as a missing person




  1. Employer accuses person of theft or other crime related to the escape




  1. Never leaving the house without employer




  1. Any other, please provide details in section F


Where indicators are identified record full details in section F



Section E: Indicators of sexual exploitation
Are any of these indicators present? (tick as applicable)

Yes  please tick all relevant boxes in section E

No  continue to section F


  1. Adverts for sexual services offering women from particular ethnic or national groups




  1. Sleeping on work premises




  1. Movement of women between brothels or working in alternate locations




  1. Women with very limited amounts of clothing or a large proportion of their clothing is ‘sexual’




  1. Only being able to speak sexual words in local language or language of client group




  1. Having tattoos or other marks indicating ‘ownership’ by their exploiters




  1. Person forced, intimidated or coerced into providing services of a sexual nature




  1. Person subjected to crimes such as abduction, assault or rape




  1. Someone other than the potential victim receives the money from clients




  1. Health symptoms (including sexual health issues)




  1. Signs of ritual abuse and witchcraft (juju)




  1. Substance misuse




  1. Any other, please provide details in section F


Where indicators are identified record full details in section F




Section F: evidence to support reasons for referral (2 pages available)
Please use this section to:

  • expand on the circumstances or details of the encounter or contact, providing background to how the information was provided (for example on first encounter during police operation)




  • provide evidence of the indicators that you have identified in sections B to E




  • note whether it is likely that further information will be become available at a later date




  • provide any other relevant information that you consider may be important and wish to include for example living or working conditions, behaviour, appearance, demeanour




  • movements in or to the UK, including dates (if known)




  • suspected place of exploitation (if known)




  • name of agent, exploiter or trafficker (if known)




  • record any action you have taken including referral to other agencies (for example The Salvation Army, police, UK Border Agency ) where appropriate

(If a separate sheet is required, please indicate that section F is continued and provide with referral)




Section

Indicator









Section

Indicator








Where to send this form:

Completed forms should be sent to the UK Human Trafficking Centre (UKHTC) via email at UKHTC@soca.x.gsi.gov.uk or by fax to 0870 496 5534.


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