Elder Financial Exploitation Red Flag Report Form

Internal form for branch staff to document and escalate suspected elder financial exploitation based on observed behavioral and transactional red flags.

Submission Notice

• What are you reporting?
• Did the customer consent to this internal escalation, if applicable?
  Only collect consent details when relevant. Internal escalation may still be required under policy even without customer consent.
• Date of report
• Time of report

Reporter Information

• Your name
• Your role or title
• Branch or office location
• Work email

Customer and Account Details

• Customer name
• Customer age range
  Use an age range instead of date of birth unless policy requires otherwise.
• Account number or masked identifier
  Use a masked account identifier when possible. Do not enter full account numbers unless required by policy.
• Your relationship to the customer

Observed Red Flags

• Observed red flag categories
• Approximate transaction amount
  Enter the approximate amount involved if a transaction is part of the concern.
• How often did the activity occur?
• Observed customer behavior
• Was a third party present or directing the interaction?
• Describe the third party's involvement
  Include only observable facts, such as who was present, what they said, and how they influenced the transaction.

Incident Narrative

• Date of incident
• Approximate time of incident
• Where did this occur?
• Describe what you observed
  Include the sequence of events, exact words if relevant, and any transaction details. Do not include unnecessary PII.

Actions Taken and Escalation

• Actions taken by staff
• Date escalated
• Time escalated
• Additional notes

Certification and Submission

• I certify that this report is accurate to the best of my knowledge and based on observed facts.
• Electronic signature