Safeguarding reporting form

This online form is to be completed when an incident of concern involving a Vulnerable Person or Young adult attending a club event has been raised

It will be sent directly to the safeguarding leads personal email or when none in post to the chairs personal email address and will be treated confidentially.

Alternatively download a word version here and hand or send to a committee member

Word version download

Safeguarding online form

Name of person completing this form

Email Address of sender

Persons of concerns name

Reasons for recording the concern (headline):

Record the following factually: When (date & time of incident or concern arising)? Where did your concerns arise? Who else – was anyone else present? What exactly did you see/hear/smell that raised your concern? What did you say to the vulnerable adult / child? N.B. Please record any direct disclosures/statements/comments using the adult’s or childs exact words in quotation marks.

Opinion: Your opinions, impressions and worries are important. Facts should be recorded in the box above but please record your opinions, impressions and worries here and state what has led you to form them (e.g. something you have noticed, feel or suspect).

Action taken, including names of everyone spoken to about the incident/concern: