Fresh Vulnerable Adults Act (VAA) Order

Questionnaire

The VULNERABLE ADULT is a person who meets all of the following elements:

is 18 years of age or older;
has mental or physical infirmity, disability or incapacity; and because of it
is unable to protect himself or herself from abuse, neglect or self-neglect.

The RESPONDENT is the person against whom the Protection Order is to be issued.

A Family Member / Donee / Deputy / Approved Welfare Officer / Adult Protection Services Officer may make this application on behalf of the Vulnerable Adult (relevant supporting documents must be available at point of application).

Identification Type*

I am applying for protection under the Vulnerable Adults Act as:*

Approved Welfare Officer

Vulnerable Adult(Myself)

I am at least 18 years old with mental capacity

A Family Member

A Donee

A Deputy

S/N	Questions	Answers
1	Is the victim a Vulnerable Adult with physical infirmity, disability or incapacity?*	Yes No
2	Is the victim a Vulnerable Adult with mental infirmity, disability or incapacity?*	Yes No
3	Has the Vulnerable Adult experience physical abuse?*	Yes No
4	Has the Vulnerable Adult experience emotional/psychological abuse?*	Yes No
5	Has the Vulnerable Adult experience any fear for his/her safety or wellbeing due to the Respondent's conduct or behaviour?*	Yes No
6	Is there unreasonable restraining or confining of Vulnerable Adult by Respondent's conduct or behaviour?*	Yes No
7	Is there a lack of provision of essential care (e.g. food, clothing, medical aid, lodging, other necessities of life, etc) to the Vulnerable Adult?*	Yes No

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Fresh Vulnerable Adults Act (VAA) Order

Questionnaire

Vulnerable Adult Information

Vulneral Adult Information

APPLICATION DRAFT