Deprivation of Liberty Form

Use the Deprivation of Liberty Form to assess the extent of confinement of a young person, and determine appropriate deprivation of liberty safeguards (DOLs).

Deprivation of Liberty Form



General Information

1. Young Person’s Name:


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2. PER Number:


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3. Legal Status:


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4. Age/DOB:


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Deprivation Of Liberty

1. Is there a potential Deprivation of Liberty?


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2. Is the person confined? (The confinement questions below will help you make that decision).


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3. Is the young person able to give consent to the confinement?


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4. Who can give consent? (NB – a) this maybe themselves, their parents or carers, otherwise this maybe the Trust.


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5. is the state responsible for the confinement? (This means that a public authority is either directly involved in the care arrangements or ought to know of the deprivation of liberty? Examples will be a child who is resident in a residential unit or foster carers home and they are confined or a social worker visits a child’s home and sees evidence of confinement.


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Confinement Questions

1. How much greater is the intensity of the supervision, support and restrictions?


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2. Can the person go out of the establishment without the carer’s permission?


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3. Can they spend nights away?


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4. To what extent is the person able to control their own finances?


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5. Can the person choose what to wear and buy their own clothes?


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6. To what extent do the rules and sanctions differ from non-disabled age appropriate settings?


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7. Are their regular private times, where the person has no direct carer supervision?


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8. What is the carer to person ratio and how different is this to what would usually be expected of someone of that age who is not disabled?


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9. Is physical intervention used?


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10. How structured is the person’s routine compared with someone of the same age and relative maturity who is not disabled?


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11. To what extent is contact with the outside world restricted?


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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