Form 48

FORM 48 (Section 672.13)

Assessment Order of the Court

Canada,

Province of

(territorial division)

Whereas I have (or if the signatory is the clerk of the court, the judge or justice has) reasonable grounds to believe that evidence of the mental condition of (name of accused), who has been charged with  , may be necessary to determine *

[ ] whether the accused is unfit to stand trial

[ ] whether the accused suffered from a mental disorder so as to exempt the accused from criminal responsibility by virtue of subsection 16(1) of the Criminal Code at the time of the act or omission charged against the accused

[ ] whether the balance of the mind of the accused was disturbed at the time of commission of the alleged offence, if the accused is a female person charged with an offence arising out of the death of her newly-born child

[ ] if a verdict of unfit to stand trial or a verdict of not criminally responsible on account of mental disorder has been rendered in respect of the accused, the appropriate disposition to be made in respect of the accused under section 672.54, 672.58 or 672.64 of the Criminal Code or whether the court should, under subsection 672.84(3) of that Act, revoke a finding that the accused is a high-risk accused

[ ] if a verdict of unfit to stand trial has been rendered in respect of the accused, whether the court should order a stay of proceedings under section 672.851 of the Criminal Code

An assessment of the mental condition of (name of accused) is ordered to be conducted by/at (name of person or service by which or place where assessment is to be made) for a period of   days.

This order is to be in force for a total of  days, including travelling time, during which time the accused is to remain 

[ ] in custody at (place where accused is to be detained)

[ ] out of custody, on the following conditions:

(set out conditions, if applicable)

Check applicable option.

Dated (date) , at  (place).

(Signature of judge, provincial court judge, justice or clerk of the court)

Form 48.1

FORM 48.1 (Section 672.13)

Assessment Order of the Review Board

Canada,

Province of

(territorial division)

Whereas I have reasonable grounds to believe that evidence of the mental condition of (name of accused), who has been charged with , may be necessary to 

[ ] if a verdict of unfit to stand trial or a verdict of not criminally responsible on account of mental disorder has been rendered in respect of the accused, make a disposition under section 672.54 of the Criminal Codeor determine whether the Review Board should, under subsection 672.84(1) of that Act, refer to the superior court of criminal jurisdiction for review a finding that the accused is a high-risk accused

[ ] if a verdict of unfit to stand trial has been rendered in respect of the accused, determine whether the Review Board should make a recommendation to the court that has jurisdiction in respect of the offence charged against the accused to hold an inquiry to determine whether a stay of proceedings should be ordered in accordance with section 672.851 of the Criminal Code

I hereby order an assessment of the mental condition of (name of accused) to be conducted by/at (name of person or service by whom or place where assessment is to be made) for a period of  days.

This order is to be in force for a total of  days, including travelling time, during which time the accused is to remain 

[ ] in custody at (place where accused is to be detained)

[ ] out of custody, on the following conditions:

(set out conditions, if applicable)

Check applicable option.

Dated this  day of  A.D. , at  .

(Signature of Chairperson of the Review Board)

Form 48.2

FORM 48.2 (Subsection 672.5(14))

Victim Impact Statement — Not Criminally Responsible

This form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you arising from the conduct for which the accused person was found not criminally responsible on account of mental disorder, as well as a description of the impact that the conduct has had on you. You may attach additional pages if you need more space.

Your statement must not include

• any statement about the conduct of the accused that is not relevant to the harm or loss suffered by you;

• any unproven allegations;

• any comments about any conduct for which the accused was not found not criminally responsible;

• any complaint about any individual, other than the accused, who was involved in the investigation or prosecution of the offence; or

• except with the court’s or Review Board’s approval, an opinion or recommendation about the disposition.

The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information.

Emotional impact

Describe how the accused’s conduct has affected you emotionally. For example, think of

• your lifestyle and activities;

• your relationships with others such as your spouse, family and friends;

• your ability to work, attend school or study; and

• your feelings, emotions and reactions as these relate to the conduct.

Physical impact

Describe how the accused’s conduct has affected you physically. For example, think of

• ongoing physical pain, discomfort, illness, scarring, disfigurement or physical limitation;

• hospitalization or surgery you have had because of the conduct of the accused;

• treatment, physiotherapy or medication you have been prescribed;

• the need for any further treatment or the expectation that you will receive further treatment; and

• any permanent or long-term disability.

Economic impact

Describe how the accused’s conduct has affected you financially. For example, think of

• the value of any property that was lost or damaged and the cost of repairs or replacement;

• any financial loss due to missed time from work;

• the cost of any medical expenses, therapy or counselling; and

• any costs or losses that are not covered by insurance.

Please note that this is not an application for compensation or restitution.

  Fears for security

Describe any fears you have for your security or that of your family and friends. For example, think of

• concerns with respect to contact with the accused; and

• concerns with respect to contact between the accused and members of your family or close friends.

Drawing, poem or letter

You may use this space to draw a picture or write a poem or letter if it will help you express the impact that the accused’s conduct has had on you.

 I would like to read or present my statement (in court or before the Review Board).

To the best of my knowledge, the information contained in this statement is true.

Dated this  day of  20, at  .

Signature of declarant

Form 49

FORM 49 (Section 672.57) Warrant of Committal

Disposition of Detention

Canada,

Province of

(territorial division)

To the peace officers in the said (territorial division) and to the keeper (administrator, warden) of the (prison, hospital or other appropriate place where the accused is detained).

This warrant is issued for the committal of A.B., of , (occupation), hereinafter called the accused.

Whereas the accused has been charged that (set out briefly the offence in respect of which the accused was charged);

And whereas the accused was found

☐ unfit to stand trial

☐ not criminally responsible on account of mental disorder

This is, therefore, to command you, in Her Majesty’s name, to take the accused in custody and convey the accused safely to the (prison, hospital or other appropriate place) at , and there deliver the accused to the keeper (administrator, warden) with the following precept:

You, the keeper (administrator, warden), are therefore directed to receive the accused in your custody in the (prison, hospital or other appropriate place) and to keep the accused safely there until the accused is delivered by due course of law.

The following are the conditions to which the accused shall be subject while in your (prison, hospital or other appropriate place):

The following are the powers regarding the restrictions (and the limits and conditions on those restrictions) on the liberty of the accused that are hereby delegated to you the said keeper (administrator, warden) of the said (prison, hospital or other appropriate place):

Check applicable option.

Dated (date) , at  (place).

(Signature of judge, provincial court judge, justice, clerk of the court or chairperson of the review board)

Form 50

FORM 50 (Subsection 672.7(2))Warrant of Committal

Placement Decision

Canada,

Province of

(territorial division)

To the peace officers in the said (territorial division) and to the keeper (administrator, warden) of the (prison, hospital or other appropriate place where the accused is detained).

This warrant is issued for the committal of A.B., of , (occupation), hereinafter called the accused.

Whereas the accused has been charged that (set out briefly the offence in respect of which the accused was charged);

And whereas the accused was found

☐ unfit to stand trial

☐ not criminally responsible on account of mental disorder

And whereas the Review Board has held a hearing and decided that the accused shall be detained in custody;

And whereas the accused is required to be detained in custody pursuant to a warrant of committal issued by (set out the name of the Judge, Clerk of the Court, Provincial Court Judge or Justice as well as the name of the court and territorial division), dated the  day of , in respect of the offence that (set out briefly the offence in respect of which the accused was charged or convicted);

This is, therefore, to command you, in Her Majesty’s name, to

☐ execute the warrant of committal issued by the court, according to its terms

☐ execute the warrant of committal issued herewith by the Review Board

Check applicable option.

Dated this  day of  A.D. , at  .

(Signature of chairperson of the Review Board)

Form 51

FORM 51 (Paragraphs 732.1(3)(c.2), 742.3(2)(a.2), 810(3.02)(c), 810.01(4.1)(g), 810.011(6)(f), 810.1(3.02)(i) and 810.2(4.1)(g))

Notice of Obligation To Provide Samples of Bodily Substance

To A.B., of , (occupation), (address in Canada), (date of birth), (gender):

Because, on (date), you were ordered, under (applicable provision) of the Criminal Code, to provide samples of a bodily substance prescribed by regulation at regular intervals for the purpose of analysis;

You are provided with this notice to inform you of your obligations with respect to providing samples.

1 On (specify a day not earlier than 24 hours after the day on which the notice is served), you must report, at any time from (time) to (time), at (address of place at which sample to be taken, as designated by the Attorney General of the province or Minister of Justice of the territory), to provide a sample of your (specify type of bodily substance prescribed by regulation).

2 Every (specify a number not less than seven) days after you first report to provide a sample, you must report, at any time from (time) to (time), at (address of place at which sample to be taken, as designated by the Attorney General of the province or Minister of Justice of the territory), to provide a sample of your (specify type of bodily substance prescribed by regulation).

3 You have the right to apply to a court to terminate the obligation to provide samples, and the right to appeal any decision of that court.

4 If you are found to have not complied with your obligation to provide samples as set out in this notice, you may be subject to a fine or imprisonment, or to both (or, in the case of a conditional sentence, you may be subject to proceedings under section 742.6 of the Criminal Code, the consequences of which may include imprisonment).

5 The results of the analysis of the bodily substances may be used or disclosed in accordance with the Criminal Code, including in proceedings against you, the result of which may be that you are subject to a fine or imprisonment, or to both (or, in the case of a conditional sentence, including in proceedings under section 742.6 of the Criminal Code, the consequences of which may include imprisonment).

Served on (date), at (place the notice is served).

(Signature of probation officer, supervisor or person designated by the Attorney General or Minister of Justice, as the case may be)

Form 52

FORM 52 (Section 490.012)

Order To Comply with Sex Offender Information Registration Act

Canada,

Province of 

(territorial division)

To A.B., of , (occupation), (address or address of court if no fixed address), (date of birth), (gender):

You have been convicted of or found not criminally responsible on account of mental disorder for (description of offence(s)) under (applicable designated offence provision(s) of theCriminal Code), a designated offence (or designated offences) within the meaning of subsection 490.011(1) of the Criminal Code.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(1) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of years after this order is made (or if paragraph 490.013(2)(c) or any of subsections 490.013(2.1) to (5) of the Criminal Code applies, for life).

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act or, if applicable, the Canadian Forces Provost Marshal, to correct the information.

6 You have the right to apply to a court to terminate this order, and the right to appeal the decision of that court.

7 If you are found to have contravened this order, you may be subject to a fine or imprisonment, or to both.

8 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Dated this  day of , at  .

(Signature of judge or clerk and name of court)

(Signature of person subject to order)

Form 53

FORM 53 (Sections 490.019 and 490.032)

Notice of Obligation To Comply with Sex Offender Information Registration Act

Canada,

Province of ,

(territorial division).

To A.B., of , (occupation), a person referred to in subsection 490.02(1) of the Criminal Code:

Because, on  (insert date(s)), you were convicted of, or found not criminally responsible on account of mental disorder for,  (insert description of offence(s)), one or more offences referred to in paragraph (a), (c), (c.1), (d), (d.1) or (e) of the definition designated offence in subsection 490.011(1) of the Criminal Code or in paragraph (a) or (c) of the definition designated offence in section 227 of the National Defence Act, under  (insert the applicable offence provision(s)), this is provided to give you notice that you are required to comply with the Sex Offender Information Registration Act.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(2) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of years after you were sentenced, or found not criminally responsible on account of mental disorder, for the offence (or if paragraph 490.022(3)(c) or (d) of the Criminal Code applies, for life) or for any shorter period set out in subsection 490.022(2) of the Criminal Code.

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act or, if applicable, the Canadian Forces Provost Marshal, to correct the information.

6 You have the right to apply to a court to exempt you from the obligation to comply with the Sex Offender Information Registration Act, and the right to appeal any decision of that court.

7 You have the right to apply to a court to terminate the obligation, and the right to appeal any decision of that court.

8 If you are found to have contravened the obligation, you may be subject to a fine or imprisonment, or to both.

9 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Dated this  day of , at  .

Form 54

FORM 54 (Sections 490.02901 to 490.02903, 490.02905 and 490.032)

Obligation To Comply with Sex Offender Information Registration Act

To A.B., of , (occupation), (address in Canada), (date of birth), (gender):

Because, on (date), you were convicted of or found not criminally responsible on account of mental disorder for an offence (or offences) in (location of offence(s)) that the Attorney General of the province, or the minister of justice of the territory, has identified as being equivalent to (description of offence(s)) under (applicable provision(s) of theCriminal Code), a designated offence (or designated offences) as defined in subsection 490.011(1) of the Criminal Code;

You are provided with this to inform you that you are required to comply with the Sex Offender Information Registration Act.

1 You must report for the first time to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under subsection 4(2) of that Act.

2 You must subsequently report to the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act, whenever required under section 4.1 or 4.3 of that Act, for a period of years after the day on which you were sentenced or found not criminally responsible on account of mental disorder for the offence (or if paragraph 490.02904(3)(c) or (d) of the Criminal Code applies, for life because you were convicted of or found not criminally responsible on account of mental disorder for (description of offence(s)) under (applicable designated offence provision(s) of theCriminal Code), a designated offence (or designated offences) within the meaning of subsection 490.011(1) of the Criminal Code) or for any shorter period determined under subsection 490.02904(2) of the Criminal Code.

3 Information relating to you will be collected under sections 5 and 6 of the Sex Offender Information Registration Act by a person who collects information at the registration centre.

4 Information relating to you will be registered in a database, and may be consulted, disclosed and used in the circumstances set out in the Sex Offender Information Registration Act.

5 If you believe that the information registered in the database contains an error or omission, you may ask a person who collects information at the registration centre referred to in section 7.1 of the Sex Offender Information Registration Act to correct the information.

6 You have the right to apply to a court to exempt you from the obligation to comply with the Sex Offender Information Registration Act, and the right to appeal the decision of that court.

7 You have the right to apply to a court to terminate the obligation to comply with the Sex Offender Information Registration Act and the right to appeal the decision of that court.

8 If you are found to have not complied with the Sex Offender Information Registration Act, you may be subject to a fine or imprisonment, or to both.

9 If you are found to have provided false or misleading information, you may be subject to a fine or imprisonment, or to both.

Served on (date).

For administrative use only:

Sentence imposed or verdict of not criminally responsible on account of mental disorder rendered on (date).