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Family Violence Initiative
Crown Case Record Sheet
Crown Case File No.
Assigned Crown
Date Assigned
Charging/Investigating Officer
Complainant
Accused
CPIC/ICON Fingerprint No.
Address
Address
Date of Incident
Information No.
Location of Incident
1 Home 2 Street 3 Work 4 Other
1 Home 2 Street 3 Work 4 Other
Nature of Incident(s)
s. 264 (1)
s. 264 (2) (a) (b) (c) (d)
s. 264 (3) (a) (b)
s. 264 (4) (a) (b)
s. 264 (5)
s. 264 (1)
s. 264 (2) (a) (b) (c) (d)
s. 264 (3) (a) (b)
s. 264 (4) (a) (b)
s. 264 (5)
Additional Charges
s. 145
s. 127
s. 733.1
s. 423
s. 264.1
s. 430
s. 372
s. 177
s. 811
s. 265
s. 267
s. 265
s. 271
s. 231 (6)
Other
s. 145
s. 127
s. 733.1
s. 423
s. 264.1
s. 430
s. 372
s. 177
s. 811
s. 265
s. 267
s. 265
s. 271
s. 231 (6)
Other
Nature of Victim/Offender Relationship
0 Unknown 1 Ex-Partner/ex-spouse 2 Partner/Spouse 3 Other relative 4 Acquintance 5 Stranger
6 Other
0 Unknown 1 Ex-Partner/ex-spouse 2 Partner/Spouse 3 Other relative 4 Acquintance 5 Stranger
6 Other
History of Previous Conduct
0 Unknown 1 Yes 2 No 3 Details
0 Unknown 1 Yes 2 No 3 Details
History of Previous Conduct with Complainant
0 None 1 No Contact Orders 2 Breaches 3 Charges 4 Convictions
0 None 1 No Contact Orders 2 Breaches 3 Charges 4 Convictions
Yes
No
Date
Details
Victim(s)
Interview
Interview
Other Witness
Interviews
Interviews
Relationship to Victim
0 Unknown 1 Ex-partner/ex-spouse 2 Parner/Spouse 3 Other relative
4 Acquaintance 5 Stranger 6 Other
0 Unknown 1 Ex-partner/ex-spouse 2 Parner/Spouse 3 Other relative
4 Acquaintance 5 Stranger 6 Other
Victim Impact
Statement
Statement
Victims
Services
Referral
Services
Referral
Risk
Assessment
Assessment
1 Low 2 Medium 3 High
Expert
Consulted
Consulted
Specialty
Recommended Actions
Warrants Issued (Arrest/Bench/Search)
Date
Outcomes
Hearing
Pre-trial Release
Conditions
Trial
Disposition
Mitigating Factors
Aggravating Factors
Sentencing
Charges Stayed Withdrawn Plea Negotiated Peace Bond
Follow Up
Yes
No
Date
Outcomes
Victim
Victim Services
Police
