Sample output: Domestic Violence Safety Referral Checklist

The fictional scenario

Sample Request — domestic-violence-safety-referral-checklist

Fictional illustration. All parties, facts, and documents below are invented for this example. The example contains no real or invented legal authority.

Please run domestic-violence-safety-referral-checklist on a family law matter where a safety concern has been raised, and organize it for our supervising attorney.

Matter facts

• The user's client: Pat Rivera (fictional), a parent.
• The other party: the client's former partner (fictional).
• Children: one child, age 5 (fictional).
• Jurisdiction: governing law not provided.

Stated facts

• The client says there is an existing protective order, entered some months ago; the client did not provide its text or precise date.
• The client describes, briefly and in their own words, two incidents and says there may be more they do not wish to detail right now.
• The client says they have some text messages and one photo saved already.
• The client says they are worried about access to housing and to a shared bank account.
• The client mentions an upcoming court date but is not sure of the exact day.
• The client does not report being in immediate danger at this moment.

Materials provided (fictional)

• None attached; the client described the above verbally.

Please: flag the safety/escalation considerations, build a document checklist and an attorney/local-resource referral checklist, and list the missing facts. Do not create a safety plan, advise on gathering evidence, or decide whether abuse occurred.

What the skill produced

Sample Output — domestic-violence-safety-referral-checklist

Draft work product for attorney review. Not legal advice. Every party, fact, and document below is fictional and illustrative. This example contains no real or invented legal authority. It shows the shape of the skill's deliverable — not a model answer for any matter.

Immediate Safety Notice

The client does not report being in immediate danger at this moment. This is recorded as the client stated it and is not treated as a conclusion that the client is safe.

• If the situation ever changes and the client is in immediate danger, the client should contact local emergency services right away, and can reach a qualified local domestic violence crisis resource at any time for support.
• The client can contact a qualified local domestic violence organization or legal-aid resource now, regardless of immediate danger, for support and options.
• This checklist does not create a safety plan and gives no emergency or crisis advice. Safety planning belongs with a qualified local domestic violence advocate.

Capability and Reliance Notice

This is a draft fact-organization and referral checklist for a qualified, licensed attorney. It does not provide legal advice, create a safety plan, advise on confrontation or evidence-gathering, determine whether abuse occurred, assess credibility, describe protective-order procedures or eligibility, or compute any deadline. A qualified attorney and the appropriate local resources must be engaged before any reliance or action.

Gates Table

Safety / Escalation Flags

The concerns the client raised, recorded neutrally and not minimized:

Existing Orders and Incidents

• Protective order: the client states one was entered "some months ago." Type, terms, and exact date not provided and marked [deadline verification required].
• Incidents: the client briefly described two incidents in their own words. Recorded only as the client chose to state them; no detail is added, no characterization is made, and whether they occurred is not assessed. The client indicated there may be more and was not pressed for detail.

Document Checklist

Records the attorney may wish to review if the client already has them — this is not a direction to collect new evidence in any way that could create risk:

• The existing protective order, if the client can obtain a copy safely.
• The text messages and the one photo the client says are already saved.
• Any prior police or court paperwork the client already holds.
• Documents relating to the housing and the shared bank account.

Attorney / Local-Resource Referral Checklist

• [ ] Engage or confirm a supervising licensed family law attorney on the matter.
• [ ] Refer the client to a qualified local domestic violence organization or legal-aid resource for support and safety planning.
• [ ] Confirm the client knows to contact local emergency services if they are ever in immediate danger.
• [ ] Through counsel, obtain the existing protective order and confirm its terms and dates.
• [ ] Through counsel, confirm the upcoming court date.

Missing Facts

• Jurisdiction and governing law — not provided [verify jurisdiction].
• The protective order's type, terms, and exact date — not provided.
• The exact upcoming court date — not provided.
• Any further detail the client may later choose to share — recorded as not provided; the client is never pressed for it.

Attorney Verification Questions

1. Confirm jurisdiction and governing law [verify jurisdiction].
2. Confirm the existing protective order's terms and dates once obtained.
3. Confirm the upcoming court date.
4. Confirm the client has been connected with a qualified local domestic violence resource.

Assumptions

• Assumed the client's account is recorded as stated; nothing is added, characterized, or assessed.
• No safety plan, no evidence-gathering advice, and no determination about whether abuse occurred is offered anywhere in this output.