• Safeguarding Report Form

  • This form is for staff, contractors or volunteers at City Life Church (or one of their projects) who don't have access to My Concern but need to report a safeguarding concern or incident, such as a disclosure, relating to someone they are working with or supporting.

    In all cases (unless it is regarding him), please call Paul Woodman (DSL) on 07387 108669 - or Naomi Sebborn (Trustee responsible for Safeguarding) on 07812 054059. If Naomi is implicated, call ThirtyOne:Eight on 0303 003 1111.

    If neither are available, email City Life Church (care@citylife.org.uk), call ThirtyOne:Eight (0303 003 1111) or if it involves a child, call Southampton City Council Children Resource Service (formerly MASH) on 02380 833004.

    Once submitted the form will be sent to Paul (or Naomi), who will contact the relevant manager(s) and partner organisations where required (e.g. HIA or SCC). If further information is required, they will contact you on the email/number provided.

  • Does the incident/concern relate to Paul Woodman?*

  • About You

  • Format: 00000-000000.
  • Which part of City Life Church are you involved with? (Please select the option that most relates to the incident/concern being reported)*

  • About the incident or concern

  • Consent

  • Has explicit consent been obtained from the adult at risk (or child's parent/carer) for referral?*

  • Data Protection and Privacy


    Information provided through this form will be processed by City Life Church for the purposes of responding to, recording, assessing and managing safeguarding concerns or incidents, protecting individuals from harm, and meeting our legal and safeguarding responsibilities.

    Please provide only information that is relevant and necessary to the concern or incident being reported. Information may include personal data and, where necessary, special category data or information relating to criminal convictions, offences or related security measures.

    Such information will be handled sensitively and confidentially and processed in accordance with the UK General Data Protection Regulation (UK GDPR), the Data Protection Act 2018 and applicable safeguarding requirements.

    Information may need to be shared with relevant staff, safeguarding professionals, statutory services, emergency services, the police, local authorities or other appropriate agencies where this is necessary to protect someone from harm or to meet a legal or safeguarding obligation.

    Where information needs to be shared for safeguarding or legal reasons, City Life Church may not be able to maintain confidentiality or obtain consent before doing so.

    For further information about how we collect, use, store and protect your personal data, please refer to our Privacy Notice: https://www.citylife.org.uk/privacy-notice/

  • What is the reason, under the Data Protection Act 1998, for making the referral without consent?*
  • Should be Empty: