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National Safer in the Home - Agency Referral Form

Purpose of this form

National Safer in the Home (SITH) is a non-crisis brokerage program that provides basic home security upgrades and remote technology safety checks for adult victim survivors of family violence who are assessed as at risk (low) or elevated (medium) risk and wish to remain safely in their home. You can read more about the program on our website.

This form is for use by professionals only and aligns with the Multi-Agency Risk Assessment and Management (MARAM) Framework. It is not a substitute for self-referral, crisis responses, or comprehensive risk management. 

Urgent safety information

If the adult victim survivor is at serious (high) risk, requires immediate protection, or there are urgent safety concerns, do not proceed with this form.

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.

Agency Referral Form

Your referral has been received; there is no need to email confirmation of submission.

National Safer in the Home is a high-volume program. Referrals are processed in date order, not by urgency.

During peak demand periods, responses may be delayed. If no response is received within four weeks, email saferinthehome@salvationarmy.org.au for an update. 

Eligibility check

If any of the below cannot be confirmed, the referral is not suitable for SITH.

If you would like to discuss your referral, please call 1300 694 167 between 9am and 4.30pm AEST/AEDT Monday to Friday (except Victorian public holidays).

Before continuing, please confirm the following

Applicant details

The applicant is the primary adult victim survivor of this referral

Pronouns
How can SITH safely contact the applicant?
Has the applicant given consent to share information with us for the purpose of this referral?

Diversity and access considerations

The following information is collected to support culturally safe and accessible service delivery.

Does the applicant identify as Aboriginal or Torres Strait Islander?
Country of birth
Language spoken at home
Does the applicant have a disability?

Children

Are children residing at the property?
Has there ever been Child Protection involvement with the applicant's child/ren?

Family violence context

In the last three months, has the applicant received high-risk funding or other safety interventions from a specialist family violence service?

Support being requested

Requests for support do not automatically result in funding and are subject to assessment based on recency, risk, eligibility, and available program resources.

For more information on the supports provided by SITH, visit our website.

Is a remote technology consultation being requested?
Are security upgrades being requested?

Tenancy and approvals

Tenancy type

Referrer details

Risk assessment

This section supports eligibility assessment for   SITH and is informed by the MARAM Comprehensive Risk Assessment Tool (see vic.gov.au for more information)

How will you be providing a current family violence risk assessment?

Referrers from specialist family violence services may complete the risk assessment included in this form OR email a MARAM (Victoria) or state-specific risk assessment reflecting the applicant's current level of risk to saferinthehome@salvationarmy.org.au with subject line Risk assessment - CLIENT NAME

Is more than one person making the applicant feel afraid (i.e. are there multiple persons using violence)?
Recent family violence information (within the last two months)
Multiple or single choice
Applicant’s self-assessment of risk
Has a safety plan been discussed with the applicant?
What is your assessment of the applicant's current family violence risk?

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