Safety Incident/Concern Report (Safeguarding)

1

Please outline below the details of the incident / concern / issue that you wish to report. It is important that you provide as much detail as possible to enable us to investigate the issue or concern thoroughly.

Once completed and submitted this form will be sent to the Designated Safeguarding Lead (DSL) and Year Group Leadership Teams for investigation.

Please be assured that this incident will be followed up as quickly as possible and dealt with in a confidential manner.

2

Name of person reporting incident* This field is required.

First Name

Last Name

4

Community* This field is required.

Darwin

Da Vinci

Franklin

5

Where did the incident occur* This field is required.

Inside School

Outside School

6

Type of Incident* This field is required.

bullying or harassment including cyber or online bullying

racist, sexist, homophobic/transphobic, religious hate incident or derogatory language

sexting or sharing of inappropriate images

swearing / abusive or aggresive language

physical aggression

self harm

suspected female genital mutilation (FGM)

Other

7

Have the Police been contacted in relation to this incident if the incident took place outside school?

Yes

No

Don't Know

8

Date of Incident

9

Time of Incident

10

Not Used* This field is required.

11

Who was involved in the incident* This field is required.

12

Full Description of the incident* This field is required.

13

Names of witnesses, if any?

14

Have you reported this incident to the police?

YESNO

15

Please upload photo here if required