Human Trafficking Victim Assessment

Personal Information

Full Name Date of Birth Gender Female Male Other Prefer not to say Contact Information Interpreter Needed? Yes No

Assessment Details

Location of Assessment Date of Assessment Name of Assessor

Indicators of Trafficking

Physical/Emotional State Signs of Control/Coercion Labour/Work Situation Control of Movement or Identification Other Indicators

Immediate Needs

Safety Concerns Support/Services Required

Additional Notes

Notes