Home-School Tutoring Hertfordshire & Cambridgeshire Safeguarding Concern Form
On submission this form will be sent directly to Sarah Jones DSL. If you have not already please alert Sarah that you have a concern via WhatsApp. Please ensure you give a factual account only and do not add your own opinions or thoughts. We will inform you on a need to know basis only of the outcome.
Your name:
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First Name
Last Name
Full name of Child
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First Name
Last Name
Date of birth
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Location of tuition
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Do you tutor the young person on your own or with another tutor/ carer?
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Nature of concern/ disclosure (Please include where you were when the child made a disclosure, what you saw, who else was there, what did the child say or do and what you said.[Ensure that if there is an injury this is recorded (size and shape) and a body map may be sent to you separately if needed][Make it clear if you have a raised a concern about a similar issue previously])
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Time and date of incident
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Signature
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Time and date form completed
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Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: