The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

LIT Lab Home | About The Explorer | Find & Compare | Explore: Michigan Lists

Here is the text we could read:

Your name:

First, middle, and last name

Date:

Our goal is to provide a safe environment for families with a friend of the court case. We often meet with both parents.
However, there are times bringing both parents together may not be appropriate. Your answers to the following questions
will help us determine whether both parents can meet together in a safe environment. The information you provide can
only be viewed by judges, referees, and friend of the court staff. It cannot be viewed by the other parent or his or her
attorney, and it cannot be used in any court proceedings. Please answer the following questions to the best of your ability.

1. Do you feel safe around the other parent?

yes

If no, please explain:

2. Is there currently or has there ever been a personal protection order or a no contact order limiting contact

between you and the other parent?

yes

If yes, please explain and include when and where:

3. Is there currently or has there ever been a personal protection order or a no contact order issued against the other

parent or you by someone else?

Unknown about other parent

include when and where:

If yes, please explain and

yes

4. Have the police been called to your home or involved in any incidents in the past year between you and the other parent?

yes

If yes, please describe:

Approved, SCAO
Form FOC 124, Rev. 2/20
Page 1 of 3

STATE OF MICHIGANCIRCUIT COURTDOMESTIC VIOLENCE SCREENINGCASE NO. and JUDGE Domestic Violence Screening
Page 2 of 3

(2/20)

Case No.

5. Have you or the other parent been arrested in the past year?

yes

If yes, please describe:

6. Have you ever felt unsafe around the other parent?

yes

If yes, please explain:

7. Is there currently or has there ever been child protective (abuse/neglect) actions involving you and/or the other parent in

Michigan or any other state or country?

yes

unknown about other parent

8. Do you have any concerns about discussing issues regarding your children in front of the other parent?

yes

9. Are you afraid that the other parent will harm or pressure you during or after a friend of the court meeting because of

what is discussed in the meeting?

yes

If yes, please explain

If yes, please explain:

Domestic Violence Screening
Page 3 of 3

(2/20)

Case No.

10. Do you have any concerns about sitting in the same room with the other parent?

yes

If yes, please explain:

11. Do you think you can speak up for yourself in a friend of the court meeting if the other parent is also present?

yes

If no, please explain:

12. Has the other parent ever made you feel threatened or harassed?

yes

If yes, please explain:

13: Is there anything not already discussed that would prevent you from participating in a friend of the court meeting with

the other parent?

yes

If yes, please explain:

Your safety is important, so please contact us to discuss any safety concerns you may have and what can be done to
address your concerns.

Date

Signature

FOC 124, Domestic Violence Screening

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/Domestic-Relations (2023-03)
Page(s): 3
Fields(s): 84
Average fields per page: 28
Reading Level: Grade 8
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

stat_e_f_michiga_n_circui_court was STATE OF MICHIGAN CIRCUIT COURT (0.65 conf)
first_middle_last_name was First middle and last name (0.37 conf)
signature_date__1 was Date (1.00 conf)
cannot_answer_questions was attorney and it cannot be used in any court proceedings Please answer the following questions to the best of your ability (0.39 conf)
feel_safe_around_parent__1 was 1 Do you feel safe around the other parent 1 (0.40 conf)
feel_safe_around_parent__2 was 1 Do you feel safe around the other parent 2 (0.40 conf)
feel_safe_around_parent__3 was 1 Do you feel safe around the other parent 3 (0.40 conf)
parent__1 was between you and the other parent 1 (0.39 conf)
parent__2 was between you and the other parent 2 (0.39 conf)
parent__3 was between you and the other parent 3 (0.39 conf)
include__1 was include when and where 1 (0.48 conf)
include__2 was include when and where 2 (0.48 conf)
include__3 was include when and where 3 (0.48 conf)
include__4 was include when and where 4 (0.48 conf)
called_involved_past_parent was 4 Have the police been called to your home or involved in any incidents in the past year between you and the other parent (0.39 conf)
yes_please_describe__1 was If yes please describe 1 (0.44 conf)
yes_please_describe__2 was If yes please describe 2 (0.44 conf)
yes_please_describe__3 was If yes please describe 3 (0.44 conf)
judge was Judge (0.39 conf)
check_box__1 was Check Box3 (0.37 conf)
check_box__2 was Check Box4 (0.37 conf)
check_box__3 was Check Box5 (0.37 conf)
check_box__4 was Check Box6 (0.37 conf)
check_box__5 was Check Box7 (0.37 conf)
check_box__6 was Check Box8 (0.37 conf)
check_box__7 was Check Box9 (0.37 conf)
check_box__8 was Check Box10 (0.37 conf)
check_box__9 was Check Box11 (0.37 conf)
parent_arrested_past_year was 5 Have you or the other parent been arrested in the past year (0.34 conf)
yes_please_describe__4 was If yes please describe 1_2 (0.45 conf)
yes_please_describe__5 was If yes please describe 2_2 (0.45 conf)
yes_please_describe__6 was If yes please describe 3_2 (0.45 conf)
ever_felt_unsafe_around_parent was 6 Have you ever felt unsafe around the other parent (0.44 conf)
yes_please_explain__1 was If yes please explain 1 (0.44 conf)
yes_please_explain__2 was If yes please explain 2 (0.44 conf)
yes_please_explain__3 was If yes please explain 3 (0.44 conf)
michigan_state_country was Michigan or any other state or country (0.43 conf)
yes_please_explain__4 was If yes please explain 1_2 (0.45 conf)
yes_please_explain__5 was If yes please explain 2_2 (0.45 conf)
yes_please_explain__6 was If yes please explain 3_2 (0.45 conf)
concerns_issues_regarding was 8 Do you have any concerns about discussing issues regarding your children in front of the other parent (0.40 conf)
yes_please_explain__7 was If yes please explain 1_3 (0.45 conf)
yes_please_explain__8 was If yes please explain 2_3 (0.45 conf)
yes_please_explain__9 was If yes please explain 3_3 (0.45 conf)
afraid_parent_harm_court was 9 Are you afraid that the other parent will harm or pressure you during or after a friend of the court meeting because of (0.37 conf)
discussed_meeting__1 was what is discussed in the meeting 1 (0.40 conf)
discussed_meeting__2 was what is discussed in the meeting 2 (0.40 conf)
discussed_meeting__3 was what is discussed in the meeting 3 (0.40 conf)
check_box__10 was Check Box12 (0.37 conf)
check_box__11 was Check Box13 (0.37 conf)
check_box__12 was Check Box14 (0.37 conf)
check_box__13 was Check Box15 (0.37 conf)
check_box__14 was Check Box16 (0.37 conf)
check_box__15 was Check Box17 (0.37 conf)
check_box__16 was Check Box18 (0.37 conf)
check_box__17 was Check Box19 (0.37 conf)
check_box__18 was Check Box20 (0.37 conf)
check_box__19 was Check Box21 (0.37 conf)
check_box__20 was Check Box22 (0.37 conf)
concerns_sitting_room_parent was 10 Do you have any concerns about sitting in the same room with the other parent (0.41 conf)
yes_please_explain__10 was If yes please explain 1_4 (0.45 conf)
yes_please_explain__11 was If yes please explain 2_4 (0.45 conf)
yes_please_explain__12 was If yes please explain 3_4 (0.45 conf)
think_speak_parent_also was 11 Do you think you can speak up for yourself in a friend of the court meeting if the other parent is also present (0.35 conf)
please_explain__1 was If no please explain 1 (0.44 conf)
please_explain__2 was If no please explain 2 (0.44 conf)
please_explain__3 was If no please explain 3 (0.44 conf)
parent_ever_made_feel was 12 Has the other parent ever made you feel threatened or harassed (0.43 conf)
yes_please_explain__13 was If yes please explain 1_5 (0.45 conf)
yes_please_explain__14 was If yes please explain 2_5 (0.45 conf)
yes_please_explain__15 was If yes please explain 3_5 (0.45 conf)
anything_already_would was 13 Is there anything not already discussed that would prevent you from participating in a friend of the court meeting with (0.44 conf)
parent__4 was the other parent 1 (0.46 conf)
parent__5 was the other parent 2 (0.46 conf)
parent__6 was the other parent 3 (0.46 conf)
signature_date__2 was Date_2 (1.00 conf)
text was Text2 (0.35 conf)
check_box__21 was Check Box23 (0.37 conf)
check_box__22 was Check Box24 (0.37 conf)
check_box__23 was Check Box25 (0.37 conf)
check_box__24 was Check Box26 (0.37 conf)
check_box__25 was Check Box27 (0.37 conf)
check_box__26 was Check Box28 (0.37 conf)
check_box__27 was Check Box29 (0.37 conf)
check_box__28 was Check Box30 (0.37 conf)

Create an Interactive Version of this Form:

The Weaver creates a draft guided interview from a template form, like the one provided here. To learn more, read "Weaving" your form into a draft interview.

The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

FOC 124, Domestic Violence Screening

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02