Concerns/ Safeguarding

Concerns/ Safeguarding
Staff/Volunteer

First NameLast Name
Are you a member of the safeguarding team or a safeguarding trustee?
Date of incident

MonthDayYear
Date
Time of the incident
Date/time this was reported?
Dementia Active Member

First NameLast Name
Who have you first reported the concerns to?
Date of Report

MonthDayYear
Date
Please describe concerns (include date/s when issues causing concern occurred)
Please try and paint a picture around the concerns
Add here any conversation you have had with the member
Please try and paint a picture around this conversation

Official Use only - Name of Safeguarding Staff Member completing this section

First NameLast Name
Categories
Reference the table to categorise the level of risk
Low Risk - Recorded Internally - Lower-level concern where threshold of further
enquiries under safeguarding are unlikely to be met. However, Dementia Active should keep a written internal record of what happened and what action was taken. (via this form)
Medium Risk - Requires Consultation - Incidents at this level could be discussed with the local authority (Oxfordshire County Council’s Safeguarding Team on 01865 328232). After the conversation, they may request you formally report the concern as a safeguarding.
High Risk - Always Reportable - Incidents at this level should be reported to your local authority and directed to the appropriate team. NB: You may need to contact the police/emergency services.
Action plan:
Action plan: Investigation: Any further conversations prior to decision re what level of risk is involved. e.g. conversation with the author of the report as written accounts often need filling in to get the full picture.Consultation with the lead safeguarding trustee unless the concern level is clearly mild.
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