Criminal Record or Abuse History

(a) Criminal Record/Abuse History Verification. (1) Confidential Document. A party’s filed Criminal Record/Abuse History Verification form shall be confidential and shall not be publicly accessible. (2) Plaintiff or Petitioner. Contemporaneous with filing a custody action or a contempt proceeding, the plaintiff or petitioner shall: (i) complete, sign, and file with the prothonotary a Criminal Record/Abuse History Verification form for the party and any member of that party’s household, as provided in subdivision (c); and (ii) serve the complaint, petition, or counterclaim on the defendant or respondent with: (A) a copy of the filed Criminal Record/Abuse History Verification form; and (B) a blank Criminal Record/Abuse History Verification form for the defendant or respondent to complete and file. (3) Defendant or Respondent. After being served pursuant to subdivision (a)(2)(ii), the defendant or respondent shall: (i) complete, sign, and serve on the plaintiff or petitioner the Criminal Record/Abuse History Verification form for the defendant or respondent and any member of that party’s household no less than one day prior to the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first; and (ii) file the completed and signed Criminal Record/Abuse History Verification form at the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first. (4) Updating Criminal Record/Abuse History Verification Form. (i) For as long as a child is subject to the court’s jurisdiction and following the initial in-person contact with the court, a party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form either five days after any change in circumstances, or no less than one day prior to any proceeding, whichever occurs first. If there is no pending proceeding, the party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form five days after any change in circumstances. A party shall report a change in circumstances of the party and any of the party’s household members. (ii) The updated Criminal Record/Abuse History Verification form shall be filed with the prothonotary within 14 days of any change in circumstances, or five days prior to any court proceeding, whichever occurs first. (5) Sanctions. A party’s failure to file an initial or updated Criminal Record/Abuse History Verification form may result in sanctions against that party. (b) Evaluation. (1) Initial Evaluation. During the initial in-person custody proceeding, the judge, conference officer, conciliator, or other appointed individual shall evaluate whether a party or household member poses a threat to the child. (i) In determining whether a party or household member poses a threat to the child or requires an additional evaluation or counseling, as provided in 23 Pa.C.S. § 5329(c)—(e), the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the party’s Criminal Record/Abuse History Verification form; and (B) other information or documentation of the party’s or household member’s criminal record or abuse history that is provided by either party. (ii) To the extent a party or household member has a criminal record relating to an enumerated offense in 23 Pa.C.S. § 5329(a) or an abuse history, the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the severity of the offense or abuse; (B) when the offense or abuse occurred; (C) if the victim was a child or family member; and (D) whether the offense or abuse involved physical violence. (2) Additional Evaluation or Counseling. If the initial evaluation set forth in subdivision (b)(1) determines that a party or household member poses a threat to the child, the conference officer, conciliator, or other appointed individual conducting the evaluation may recommend to the judge and the judge may order: (i) a party or party’s household member to undergo an additional evaluation or counseling by a mental health professional appointed by the court; or (ii) temporary custody pending the additional evaluation or counseling. (c) Form. The verification regarding criminal record or abuse history shall be substantially in the following form: (Caption) CRIMINAL RECORD / ABUSE HISTORY VERIFICATION REPORT OF CHILD ABUSE AND PROTECTIVE SERVICES REQUESTED BY COURT (Court may use the first page of the parties’ criminal record/ abuse history verification or may complete a new form.) 1. Participants. Please list ALL members in your/the participant’s household and attach sheets if necessary: Name Date of Birth Address Relationship to Child(ren) Party requests their residence remain confidential as they are protected by the Protection from Abuse Act, 23 Pa.C.S. § 6112, or the Domestic and Sexual Violence Victim Address Confidentiality Act, 23 Pa.C.S. § § 6701—6713, or the Child Custody Act, 23 Pa.C.S. § 5336(b), or they are in the process of seeking protection under the same. Please list ALL members in the opposing party’s household and attach sheets if necessary: Name Date of Birth Address Relationship to Child(ren) Party requests their residence remain confidential as they are protected by the Protection from Abuse Act, 23 Pa.C.S. § 6112, or the Domestic and Sexual Violence Victim Address Confidentiality Act, 23 Pa.C.S. § § 6701—6713, or the Child Custody Act, 23 Pa.C.S. § 5336(b), or they are in the process of seeking protection under the same. SUBJECT CHILD(REN) —Attach additional sheets if necessary: Name Date of Birth ***End of Page 1*** 2. Criminal Offenses. As to the following listed Pennsylvania crimes or offenses, or another jurisdiction’s substantially equivalent crimes or offenses, check the box next to any applicable crime or offense in which you or a household member: • has pleaded guilty or no contest; • has been convicted; • has charges pending; or • has been adjudicated delinquent under the Juvenile Act, 42 Pa.C.S. § § 6301—6375, and the record is publicly available as set forth in 42 Pa.C.S. § 6307. You should also check the box next to a listed criminal offense even if the offense has been resolved by Accelerated Rehabilitative Disposition (ARD) or another diversionary program, unless it has been expunged pursuant to 18 Pa.C.S. § 9122, or a court has entered an order for limited access, e.g. , Clean Slate, pursuant to 18 Pa.C.S. § § 9122.1 or 9122.2. Check all that apply Crime Self Other household member Date of conviction, guilty plea, no contest plea, or pending charges Sentence 18 Pa.C.S. Ch. 25 (relating to criminal homicide) 18 Pa.C.S. § 2701 (relating to simple assault) 18 Pa.C.S. § 2702 (relating to aggravated assault) 18 Pa.C.S. § 2705 (relating to recklessly endangering another person) 18 Pa.C.S. § 2706 (relating to terroristic threats) 18 Pa.C.S. § 2709.1 (relating to stalking) 18 Pa.C.S. § 2718 (relating to strangulation) 18 Pa.C.S. § 2901 (relating to kidnapping) 18 Pa.C.S. § 2902 (relating to unlawful restraint) 18 Pa.C.S. § 2903 (relating to false imprisonment) 18 Pa.C.S. § 2904 (relating to interference with custody of children) 18 Pa.C.S. § 2910 (relating to luring a child into a motor vehicle or structure) 18 Pa.C.S. Ch. 30 (relating to human trafficking) 18 Pa.C.S. § 3121 (relating to rape) 18 Pa.C.S. § 3122.1 (relating to statutory sexual assault) 18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse) 18 Pa.C.S. § 3124.1 (relating to sexual assault) 18 Pa.C.S. § 3125 (relating to aggravated indecent assault) 18 Pa.C.S. § 3126 (relating to indecent assault) 18 Pa.C.S. § 3127 (relating to indecent exposure) 18 Pa.C.S. § 3129 (relating to sexual intercourse with animal) 18 Pa.C.S. § 3130 (relating to conduct relating to sex offenders) 18 Pa.C.S. § 3301 (relating to arson and related offenses) 18 Pa.C.S. § 4302 (relating to incest) 18 Pa.C.S. § 4303 (relating to concealing death of child) 18 Pa.C.S. § 4304 (relating to endangering welfare of children) 18 Pa.C.S. § 4305 (relating to dealing in infant children) 18 Pa.C.S. § 5533 (relating to cruelty to animal) 18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal) 18 Pa.C.S. § 5543 (relating to animal fighting) 18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia) 18 Pa.C.S. § 5902(b) or (b.1) (relating to prostitution and related offenses) 18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances) 18 Pa.C.S. § 6301 (relating to corruption of minors) 18 Pa.C.S. § 6312 (relating to sexual abuse of children) 18 Pa.C.S. § 6318 (relating to unlawful contact with minor) 18 Pa.C.S. § 6320 (relating to sexual exploitation of children) Finding of contempt of a Protection from Abuse order or agreement under 23 Pa.C.S. § 6114 Finding of contempt of a Protection of Victims of Sexual Violence and Intimidation order or agreement under 42 Pa.C.S. § 62A14 Driving under the influence of drugs or alcohol Manufacture, sale, delivery, holding, offering for sale or possession of any controlled substance or other drug or device 3. Abuse or Agency Involvement. Check the box next to any statement that applies to you, a household member, or your child. Check all that apply Self Household member Child Involvement with a children and youth social service agency in Pennsylvania or a similar agency in another jurisdiction. What jurisdiction?: A determination or finding of abuse ( i.e. , indicated or founded report) by a children and youth social service agency or court in Pennsylvania or a similar agency or court in another jurisdiction. What jurisdiction?: An adjudication of dependency involving this child or any other child under Pennsylvania’s Juvenile Act, or a similar law in another jurisdiction. What jurisdiction?: Is the case active?: A history of perpetrating ‘‘abuse’’ as that term is defined in the Protection from Abuse Act, 23 Pa.C.S. § 6102. A history of perpetrating ‘‘sexual violence’’ or ‘‘intimidation’’ as those terms are defined in 42 Pa.C.S. § 62A03 (relating to protection of victims of sexual violence and intimidation). Other 4. If you checked a box in (2) or (3), list any evaluation, counseling, or other treatment received as a result: 5. If you checked a box in (2) or (3) that applies to your household member, who is not a party, state that person’s name, date of birth, and relationship to the child. 6. If you are aware that the other party or the other party’s household member has a criminal record or abuse history, please explain: ONLY A PARTY CAN SIGN THIS FORM. IF A PARTY IS REPRESENTED BY AN ATTORNEY, THE ATTORNEY CANNOT SIGN THIS FORM ON BEHALF OF THE PARTY. I verify that the information above is true and correct to the best of my knowledge, information, or belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. … Date Plaintiff/Defendant Signature Printed Name I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that require filing confidential information and documents differently than non-confidential information and documents. Signature of Filer Printed Name Comment: There is no obligation for the court to conduct an independent investigation of the criminal record or abuse history of a party or the party’s household member. The intent of subdivision (a)(4) is for the parties to have the most current information available, including after a final order—provided the child remains under the court’s jurisdiction. As used in subdivision (a), a ‘‘child custody action’’ is intended to include any action where custody is sought to be awarded, including a protection from abuse action. An Criminal Record/Abuse History Verification form is not required in a protection from abuse action if custody is not sought. See 23 Pa.C.S. § 5322 (defining ‘‘household member’’). For subdivision (c)(6), see Pa.R.Civ.P. 1930.5 (discovery in domestic relations matters) and Pa.R.E. 614 (court’s calling or examining a witness). Given the sensitive nature of the record, see Pa.R.Civ.P. 1930.1 (form of caption and applicability of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania ). Source The provisions of this Rule 1915.3-2 adopted August 1, 2013, effective September 3, 2013, 43 Pa.B. 4702; amended May 14, 2014, effective in 30 days on June 13, 2014, 44 Pa.B. 3233; amended July 20, 2015, effective September 1, 2015, 45 Pa.B. 4158; amended August 9, 2024, effective August 13, 2024, 54 Pa.B. 5353; amended April 25, 2025, effective July 1, 2025, 55 Pa.B. 3342. Immediately preceding text appears at serial pages (420475) to (420481). (1) Confidential Document. A party’s filed Criminal Record/Abuse History Verification form shall be confidential and shall not be publicly accessible. (2) Plaintiff or Petitioner. Contemporaneous with filing a custody action or a contempt proceeding, the plaintiff or petitioner shall: (i) complete, sign, and file with the prothonotary a Criminal Record/Abuse History Verification form for the party and any member of that party’s household, as provided in subdivision (c); and (ii) serve the complaint, petition, or counterclaim on the defendant or respondent with: (A) a copy of the filed Criminal Record/Abuse History Verification form; and (B) a blank Criminal Record/Abuse History Verification form for the defendant or respondent to complete and file. (3) Defendant or Respondent. After being served pursuant to subdivision (a)(2)(ii), the defendant or respondent shall: (i) complete, sign, and serve on the plaintiff or petitioner the Criminal Record/Abuse History Verification form for the defendant or respondent and any member of that party’s household no less than one day prior to the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first; and (ii) file the completed and signed Criminal Record/Abuse History Verification form at the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first. (4) Updating Criminal Record/Abuse History Verification Form. (i) For as long as a child is subject to the court’s jurisdiction and following the initial in-person contact with the court, a party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form either five days after any change in circumstances, or no less than one day prior to any proceeding, whichever occurs first. If there is no pending proceeding, the party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form five days after any change in circumstances. A party shall report a change in circumstances of the party and any of the party’s household members. (ii) The updated Criminal Record/Abuse History Verification form shall be filed with the prothonotary within 14 days of any change in circumstances, or five days prior to any court proceeding, whichever occurs first. (5) Sanctions. A party’s failure to file an initial or updated Criminal Record/Abuse History Verification form may result in sanctions against that party. (b) Evaluation. (1) Initial Evaluation. During the initial in-person custody proceeding, the judge, conference officer, conciliator, or other appointed individual shall evaluate whether a party or household member poses a threat to the child. (i) In determining whether a party or household member poses a threat to the child or requires an additional evaluation or counseling, as provided in 23 Pa.C.S. § 5329(c)—(e), the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the party’s Criminal Record/Abuse History Verification form; and (B) other information or documentation of the party’s or household member’s criminal record or abuse history that is provided by either party. (ii) To the extent a party or household member has a criminal record relating to an enumerated offense in 23 Pa.C.S. § 5329(a) or an abuse history, the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the severity of the offense or abuse; (B) when the offense or abuse occurred; (C) if the victim was a child or family member; and (D) whether the offense or abuse involved physical violence. (2) Additional Evaluation or Counseling. If the initial evaluation set forth in subdivision (b)(1) determines that a party or household member poses a threat to the child, the conference officer, conciliator, or other appointed individual conducting the evaluation may recommend to the judge and the judge may order: (i) a party or party’s household member to undergo an additional evaluation or counseling by a mental health professional appointed by the court; or (ii) temporary custody pending the additional evaluation or counseling. (c) Form. The verification regarding criminal record or abuse history shall be substantially in the following form: (Caption) CRIMINAL RECORD / ABUSE HISTORY VERIFICATION REPORT OF CHILD ABUSE AND PROTECTIVE SERVICES REQUESTED BY COURT (Court may use the first page of the parties’ criminal record/ abuse history verification or may complete a new form.) 1. Participants. Please list ALL members in your/the participant’s household and attach sheets if necessary: Name Date of Birth Address Relationship to Child(ren) Party requests their residence remain confidential as they are protected by the Protection from Abuse Act, 23 Pa.C.S. § 6112, or the Domestic and Sexual Violence Victim Address Confidentiality Act, 23 Pa.C.S. § § 6701—6713, or the Child Custody Act, 23 Pa.C.S. § 5336(b), or they are in the process of seeking protection under the same. Please list ALL members in the opposing party’s household and attach sheets if necessary: Name Date of Birth Address Relationship to Child(ren) Party requests their residence remain confidential as they are protected by the Protection from Abuse Act, 23 Pa.C.S. § 6112, or the Domestic and Sexual Violence Victim Address Confidentiality Act, 23 Pa.C.S. § § 6701—6713, or the Child Custody Act, 23 Pa.C.S. § 5336(b), or they are in the process of seeking protection under the same. SUBJECT CHILD(REN) —Attach additional sheets if necessary: Name Date of Birth ***End of Page 1*** 2. Criminal Offenses. As to the following listed Pennsylvania crimes or offenses, or another jurisdiction’s substantially equivalent crimes or offenses, check the box next to any applicable crime or offense in which you or a household member: • has pleaded guilty or no contest; • has been convicted; • has charges pending; or • has been adjudicated delinquent under the Juvenile Act, 42 Pa.C.S. § § 6301—6375, and the record is publicly available as set forth in 42 Pa.C.S. § 6307. You should also check the box next to a listed criminal offense even if the offense has been resolved by Accelerated Rehabilitative Disposition (ARD) or another diversionary program, unless it has been expunged pursuant to 18 Pa.C.S. § 9122, or a court has entered an order for limited access, e.g. , Clean Slate, pursuant to 18 Pa.C.S. § § 9122.1 or 9122.2. Check all that apply Crime Self Other household member Date of conviction, guilty plea, no contest plea, or pending charges Sentence 18 Pa.C.S. Ch. 25 (relating to criminal homicide) 18 Pa.C.S. § 2701 (relating to simple assault) 18 Pa.C.S. § 2702 (relating to aggravated assault) 18 Pa.C.S. § 2705 (relating to recklessly endangering another person) 18 Pa.C.S. § 2706 (relating to terroristic threats) 18 Pa.C.S. § 2709.1 (relating to stalking) 18 Pa.C.S. § 2718 (relating to strangulation) 18 Pa.C.S. § 2901 (relating to kidnapping) 18 Pa.C.S. § 2902 (relating to unlawful restraint) 18 Pa.C.S. § 2903 (relating to false imprisonment) 18 Pa.C.S. § 2904 (relating to interference with custody of children) 18 Pa.C.S. § 2910 (relating to luring a child into a motor vehicle or structure) 18 Pa.C.S. Ch. 30 (relating to human trafficking) 18 Pa.C.S. § 3121 (relating to rape) 18 Pa.C.S. § 3122.1 (relating to statutory sexual assault) 18 Pa.C.S. § 3123 (relating to involuntary deviate sexual intercourse) 18 Pa.C.S. § 3124.1 (relating to sexual assault) 18 Pa.C.S. § 3125 (relating to aggravated indecent assault) 18 Pa.C.S. § 3126 (relating to indecent assault) 18 Pa.C.S. § 3127 (relating to indecent exposure) 18 Pa.C.S. § 3129 (relating to sexual intercourse with animal) 18 Pa.C.S. § 3130 (relating to conduct relating to sex offenders) 18 Pa.C.S. § 3301 (relating to arson and related offenses) 18 Pa.C.S. § 4302 (relating to incest) 18 Pa.C.S. § 4303 (relating to concealing death of child) 18 Pa.C.S. § 4304 (relating to endangering welfare of children) 18 Pa.C.S. § 4305 (relating to dealing in infant children) 18 Pa.C.S. § 5533 (relating to cruelty to animal) 18 Pa.C.S. § 5534 (relating to aggravated cruelty to animal) 18 Pa.C.S. § 5543 (relating to animal fighting) 18 Pa.C.S. § 5544 (relating to possession of animal fighting paraphernalia) 18 Pa.C.S. § 5902(b) or (b.1) (relating to prostitution and related offenses) 18 Pa.C.S. § 5903(c) or (d) (relating to obscene and other sexual materials and performances) 18 Pa.C.S. § 6301 (relating to corruption of minors) 18 Pa.C.S. § 6312 (relating to sexual abuse of children) 18 Pa.C.S. § 6318 (relating to unlawful contact with minor) 18 Pa.C.S. § 6320 (relating to sexual exploitation of children) Finding of contempt of a Protection from Abuse order or agreement under 23 Pa.C.S. § 6114 Finding of contempt of a Protection of Victims of Sexual Violence and Intimidation order or agreement under 42 Pa.C.S. § 62A14 Driving under the influence of drugs or alcohol Manufacture, sale, delivery, holding, offering for sale or possession of any controlled substance or other drug or device 3. Abuse or Agency Involvement. Check the box next to any statement that applies to you, a household member, or your child. Check all that apply Self Household member Child Involvement with a children and youth social service agency in Pennsylvania or a similar agency in another jurisdiction. What jurisdiction?: A determination or finding of abuse ( i.e. , indicated or founded report) by a children and youth social service agency or court in Pennsylvania or a similar agency or court in another jurisdiction. What jurisdiction?: An adjudication of dependency involving this child or any other child under Pennsylvania’s Juvenile Act, or a similar law in another jurisdiction. What jurisdiction?: Is the case active?: A history of perpetrating ‘‘abuse’’ as that term is defined in the Protection from Abuse Act, 23 Pa.C.S. § 6102. A history of perpetrating ‘‘sexual violence’’ or ‘‘intimidation’’ as those terms are defined in 42 Pa.C.S. § 62A03 (relating to protection of victims of sexual violence and intimidation). Other 4. If you checked a box in (2) or (3), list any evaluation, counseling, or other treatment received as a result: 5. If you checked a box in (2) or (3) that applies to your household member, who is not a party, state that person’s name, date of birth, and relationship to the child. 6. If you are aware that the other party or the other party’s household member has a criminal record or abuse history, please explain: ONLY A PARTY CAN SIGN THIS FORM. IF A PARTY IS REPRESENTED BY AN ATTORNEY, THE ATTORNEY CANNOT SIGN THIS FORM ON BEHALF OF THE PARTY. I verify that the information above is true and correct to the best of my knowledge, information, or belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. … Date Plaintiff/Defendant Signature Printed Name I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that require filing confidential information and documents differently than non-confidential information and documents. Signature of Filer Printed Name Comment: There is no obligation for the court to conduct an independent investigation of the criminal record or abuse history of a party or the party’s household member. The intent of subdivision (a)(4) is for the parties to have the most current information available, including after a final order—provided the child remains under the court’s jurisdiction. As used in subdivision (a), a ‘‘child custody action’’ is intended to include any action where custody is sought to be awarded, including a protection from abuse action. An Criminal Record/Abuse History Verification form is not required in a protection from abuse action if custody is not sought. See 23 Pa.C.S. § 5322 (defining ‘‘household member’’). For subdivision (c)(6), see Pa.R.Civ.P. 1930.5 (discovery in domestic relations matters) and Pa.R.E. 614 (court’s calling or examining a witness). Given the sensitive nature of the record, see Pa.R.Civ.P. 1930.1 (form of caption and applicability of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania ). Source The provisions of this Rule 1915.3-2 adopted August 1, 2013, effective September 3, 2013, 43 Pa.B. 4702; amended May 14, 2014, effective in 30 days on June 13, 2014, 44 Pa.B. 3233; amended July 20, 2015, effective September 1, 2015, 45 Pa.B. 4158; amended August 9, 2024, effective August 13, 2024, 54 Pa.B. 5353; amended April 25, 2025, effective July 1, 2025, 55 Pa.B. 3342. Immediately preceding text appears at serial pages (420475) to (420481). (2) Plaintiff or Petitioner. Contemporaneous with filing a custody action or a contempt proceeding, the plaintiff or petitioner shall: (i) complete, sign, and file with the prothonotary a Criminal Record/Abuse History Verification form for the party and any member of that party’s household, as provided in subdivision (c); and (ii) serve the complaint, petition, or counterclaim on the defendant or respondent with: (A) a copy of the filed Criminal Record/Abuse History Verification form; and (B) a blank Criminal Record/Abuse History Verification form for the defendant or respondent to complete and file. (3) Defendant or Respondent. After being served pursuant to subdivision (a)(2)(ii), the defendant or respondent shall: (i) complete, sign, and serve on the plaintiff or petitioner the Criminal Record/Abuse History Verification form for the defendant or respondent and any member of that party’s household no less than one day prior to the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first; and (ii) file the completed and signed Criminal Record/Abuse History Verification form at the initial in-person contact with the court or within 30 days of service of the initiating pleading, whichever occurs first. (4) Updating Criminal Record/Abuse History Verification Form. (i) For as long as a child is subject to the court’s jurisdiction and following the initial in-person contact with the court, a party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form either five days after any change in circumstances, or no less than one day prior to any proceeding, whichever occurs first. If there is no pending proceeding, the party shall complete, sign, and serve on the other parties an updated Criminal Record/Abuse History Verification form five days after any change in circumstances. A party shall report a change in circumstances of the party and any of the party’s household members. (ii) The updated Criminal Record/Abuse History Verification form shall be filed with the prothonotary within 14 days of any change in circumstances, or five days prior to any court proceeding, whichever occurs first. (5) Sanctions. A party’s failure to file an initial or updated Criminal Record/Abuse History Verification form may result in sanctions against that party. (b) Evaluation. (1) Initial Evaluation. During the initial in-person custody proceeding, the judge, conference officer, conciliator, or other appointed individual shall evaluate whether a party or household member poses a threat to the child. (i) In determining whether a party or household member poses a threat to the child or requires an additional evaluation or counseling, as provided in 23 Pa.C.S. § 5329(c)—(e), the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the party’s Criminal Record/Abuse History Verification form; and (B) other information or documentation of the party’s or household member’s criminal record or abuse history that is provided by either party. (ii) To the extent a party or household member has a criminal record relating to an enumerated offense in 23 Pa.C.S. § 5329(a) or an abuse history, the judge, conference officer, conciliator, or other appointed individual shall consider: (A) the severity of the offense or abuse; (B) when the offense or abuse occurred; (C) if the victim was a child or family member; and (D) whether the offense or abuse involved physical violence. (2) Additional Evaluation or Counseling. If the initial evaluation set forth in subdivision (b)(1) determines that a party or household member poses a threat to the child, the conference officer, conciliator, or other appointed individual conducting the evaluation may recommend to the judge and the judge may order: (i) a party or party’s household member to undergo an additional evaluation or counseling by a mental health professional appointed by the court; or (ii) temporary custody pending the additional evaluation or counseling. (c) Form [Form templates omitted to keep this record searchable. This rule prescribes official court forms — see the full templates at the official source: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/231/chapter1915/s1915.3-2.html&d=]