APPENDIX3 Monthly Reporting Form-SGBV Programme by eot15664

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									Monthly Reporting Form - SGBV Programme                                                                  Appendix 3




                                                                                                                      Appendix 1
APPENDIX 3
Monthly Reporting Form – SGBV




                                                                                                                      Appendix 1.1
Programme
(This form is adapted from Tanzanian refugee situations)




                                                                                                                      Appendix 2
 Sub-Office:                                  Month:             Year:
 _____________________________                ________________   _____________________

 TYPE OF INCIDENT               NUMBER OF REPORTS

 Name of Camp/Site                                               TOTAL       Prev        Cumulative
                                                                             Month       Since January




                                                                                                                      Appendix 3
 Rape (new this month)

 Rape (before arrival in the
 camp)

 Attempted Rape

 Sexual Harassment




                                                                                                                      Appendix 4
 Forced Marriage

 Early Marriage

 Domestic Violence

 Other Gender-Based
 Violence

 Non-Gender-Based Violence

 TOTAL ALL TYPES


Legal Protection

 INDICATORS                          No.         INDICATORS                                   No.

 Total number of SGBV cases                      Number of acquittals/convictions after six
 pending in court at start of                    (6) months of filing charges
 month

 Total number of SGBV cases                      Number of cases dismissed
 filed in court this month

 Total number of SGBV cases                      Total cases pending in court end of the
 re-filed in court this month                    month

 Number of convictions within
 six (6) months of filing charges

 Narrative: (problems, solutions, issues, training, etc.)




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      Sexual and Gender-Based Violence against Refugees, Returnees and Internally Displaced Persons




       Health

        INDICATORS                               No.          INDICATORS                              No.

        Total number of rape cases seen in                    Of these, number of rape cases
        heath centres for examination and                     seen within three (3) days of
        treatment                                             incident

        Narrative: (problems, solutions, issues, training, etc.)




       Community/Psycho-Social

        INDICATORS                               No.          INDICATORS                              No.

        Total number of SGBV cases
        receiving counseling/support

        Narrative: (problems, solutions, issues, training, etc.)




       Security/Safety

        INDICATORS                               No.          INDICATORS                              No.

        Number of SGBV cases reported to                      Percentage increase/decrease
        police                                                over last month


                                Prevention Activities: (narrative)

                                Co-ordination Activities: (narrative)




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