ࡱ> >@=@  jbjbqq I%l22222228 LLL"nnnIII, 2IIIII22nnLI2n2nF"h@2222I228e4dx x Pro-forma for Impact Assessment Name of policy/function being assessed: Name of manager/group carrying out the assessment:Has the Initial Screening form been completed? YesIs this a new or existing policy/function?1. In what areas are there concerns that the policy/function could have a differential impact (please circle.)Gender Race Disability Sexuality Age (younger or older people)2. What sort of concerns are there that the policy/function could have a differential impact on other groups? Please give details (continue overleaf if necessary). 3. What evidence do you have for this? 4. What are the risks associated with the policy in relation to the differential impact?  5. What are the expected benefits of the policy? 6. Which relevant experts or equalities groups have you approached to explore these issues? (Please give dates and details of contact). 7. How have you gained the views of these experts/groups? (e.g. by letter, meetings, interviews, fora, workshops, questionnaires, or any other method? 8. Please give details of the views of the experts/groups on the issues involved. 9. Taking into account these views, and the available evidence, please outline the risks associated with the policy/function weighed against the benefits. 10. What changes/modifications will now be made to the policy/function in the light of this Impact Assessment? 11. How will these changes/modifications be communicated to interested parties (i.e. the groups which were adversely affected) and those consulted? 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