Mortuary Identification Assessment Form
Use this form to document and assess identification details for a deceased individual in mortuary care.
Deceased Identification Details
Deceased Full Name
First Name
Middle Name
Last Name
Deceased Identifier
Date of Death
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Estimated Age (Years)
Sex / Gender Observed or Recorded
Female
Male
Intersex
Unknown
Other
Body Received Location
*
Identification Assessment
Identification Assessment Grid
*
Rows
Confirmed Match
Partial Match
No Match
Not Observed
Clothing
1
2
3
4
Distinguishing Marks
5
6
7
8
Tattoos
9
10
11
12
Scars
13
14
15
16
Jewelry
17
18
19
20
Hairstyle
21
22
23
24
Body Condition
25
26
27
28
Identification Status
*
Please Select
Confirmed
Probable
Pending
Unable to Assess
Confidence / Match Quality
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
Verifier and Case Follow-up
Assessor Name
*
First Name
Last Name
Role / Title
*
Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Follow-up Notes / Next Steps
Submit
Should be Empty: