Safeguarding incident reporting form

Safeguarding incident reporting form
This form should be used to record safeguarding concerns relating to young people. In an emergency please do not delay in informing the police or social services.

Please provide as much information as possible and the relevant member of the safeguarding team will follow up with you directly.
1 Your name
2 Your contact details (email address and phone number)
3 Details of person(s) affected (e.g. young person supported by a Charity Partner, young person attending an engagement event)
4 Your relationship to the affected person / organisation (eg Charity Partner's Investment Manager, Impetus representative at engagement event)
5 Please broadly outline the safeguarding concern
6 Date time and location of the incident

DayMonthYear
Date
7 Other present or potential witnesses
8 Any further information or action taken
Should be Empty: