Reporting a Safeguarding Concern Form - Only for External Staff

Reporting a Safeguarding Concern Form - Only for External Staff
For completion by staff or volunteers when they become aware of child welfare concerns in accordance with government guidance and the child protection policy.

The Designated Safeguarding Lead will monitor concerns and report where appropriate to Children’s Social Care if a child is deemed at risk of significant harm. This information will be disclosed only to those staff who need to know for the purposes of child protection. Concerns should usually be shared with parent/child,
unless to do so may place a child/ren at increased risk of harm (if in doubt about this, the DSL should consult with Children’s Social Care). Please write legibly and do not use acronyms.

Exact words must be used even if they may offend.
Date of alleged incident*

DayMonthYear
Date
Full Name of Child(ren)*
Class Year*
Full Name of person making this record*
Designation/Position*
Date of Disclosure*

DayMonthYear
Date
Time of disclosure*
Date of referral to DSL*

DayMonthYear
Date
Time of referral to DSL*
Signed as a true record*

Clear
Date*

DayMonthYear
Date
Nature of Concern (Include observations as well as professional opinions)*
Body Map Used*

YesNo
You can download the body map by clicking here and complete it accordingly. You can scan or take a clear picture of the completed map and upload below.

Under no circumstances should a member of staff ask a child to remove clothing to see a suspected injury. If a child has described where an injury is, or it is clearly visible without needing to remove outer clothing, please indicate below
Upload completed body map*

Cancelof
Any other relevant information (previous concern, other professionals involved/SEN details etc.)*
Status with social care (please tick & name where known)*

NoneKnown to social careAllocated social workerChild Protection Plan
Name of social worker if applicable
Should be Empty: