KCC - Incident Reporting Form

Kesgrave CC - Incident Reporting Form
If this incident is an emergency and/or you are concerned that someone is at immediate risk of harm, please call the Police immediately on 999.
Date form completed

DayMonthYear
Date
Name of person completing form

First NameLast Name
Name of person against whom allegation is being made

First NameLast Name
Date of incident

DayMonthYear
Date
Time of incident

Hour Minutes

AM/PM Option
Location of incident
Your account of incident - please provide names of any further people being alleged
Have any injuries been sustained? If so, describe any treatment given and by who?
Are there any witnesses? If so, please give their name and their involvement
If you are under 18, please provide the name of a parent/carer

First NameLast Name
If you are under 18, please provide the phone number of a parent/carer
If you are under 18, please provide the email address of a parent/carer
example@example.com
Thank you for completing this form. It will be forwarded to the Club Safeguarding Officer and reviewed as soon as possible. Please be aware that any required investigation may take time to complete, but if your concern is such that someone is at immediate risk of harm, you should call the Police immediately on 999. Your concern will also be reported to the County Cricket Safeguarding Officer. It is likely you will be contacted to discuss the concern, however, if this isn't required, you will be notified when any subsequent investigation has concluded and any action taken.

Please now SUBMIT the form.
Should be Empty:

Kesgrave CC - Incident Reporting Form