ࡱ> hjgc bjbj .lMbMb %8N,zD: 0"$j! $   R    @C R  0: $_$ $  Q: $B :  Initial Equality Impact Assessment (IEIA) Form Policy name Version Name of individual completing assessment Job title Date Which groups may be affected differently by the policy? GroupIs there potential for differential impact?Reasons/EvidenceAgeY NGender reassignment Y NMarriage or civil partnershipY NPregnancy or maternityY NDisabilityY NRace (including colour, nationality, ethnic or national origin)Y NReligion or beliefY NSexY NSexual orientationY NAny other groupY N Do you recommend a Full Equality Impact Assessment be carried out on this policy? Full EIA required Full EIA not required Please submit this form to the Policy Manager at the same time as your policy. For reviewers use IEIA reference number: Does this policy require a FEIA? Yes No If unsure, you can ask the initial assessor for more information. Please explain your decision Name of reviewer 1 Job titleDateName of reviewer 2 Job titleDate Full Equality Impact Assessment (FEIA) Form Policy name VersionName of individual completing assessment Job titleDate Was any consultation done in relation to this policy? E.g. individuals from impacted groups, external expert organisations, individuals in the area of work. Y N If Y, please elaborateWhat are the arrangements for monitoring and reviewing the actual impact of the policy?  Which groups may be affected differently by the policy? GroupIs there a potential for differential impact?Reasons/evidenceActions to address impactAgeY NGender reassignment Y NMarriage or civil partnershipY NPregnancy or maternityY NDisabilityY NRace (including colour, nationality, ethnic or national origin)Y NReligion or beliefY NSexY NSexual orientationY NAny other groupY N For reviewers use FEIA reference number: Final decision: No barriers or impact identified; policy can proceed through approval process Barriers or impact identified; changes have been made to mitigate effects Barriers or impact identified; however, no proportionate changes can be identified If unsure, you can ask the initial assessor for more information. 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