IGA Safeguarding Reporting Form

We'd really appreciate it if you could take the time to fill out the sections below with as much detail as possible regarding any safeguarding concerns you may have. This will enable us to address the issues effectively. Once you've completed the form, a member of our national safeguarding team will get in touch with you as soon as they can using the contact information provided. Our goal is to respond to all concerns within 5 working days.

In case of immediate danger or if a criminal offense has occurred, please don't hesitate to contact the police right away at 999.

Your safety is our priority, and in some cases, we may need to share information with relevant agencies to ensure the safety of children and adults. However, rest assured that confidentiality will be maintained wherever appropriate, and information will only be shared with those who genuinely need to know.

If you have any questions or need to speak with someone directly, please feel free to reach out to the appropriate safeguarding team at: safeguarding@igauk.com.

We're here to help.

Person reporting the Safeguarding concern:

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter your contact number

Role:*

Persons Involved

We kindly ask that you provide as much detail as you can about the individual involved in the safeguarding concern. Your thoroughness will greatly assist us in addressing the matter effectively and ensuring the safety of all involved.

Alleged Victims Details

Adult (18+) or Child?*

Adult (18+)Child

Name*

First NameLast Name

Email

Email of Victim/Parent/Guardian/Appropriate Adult example@example.com

Contact Number

Contact number of Victim/Parent/Guardian/Appropriate Adult

Subject of Concern

Name*

First NameLast Name

Role:*

Email*

example@example.com

Actions already taken:

Are you aware of any local authority/police involvement in this case? If yes, please provide details

Have any of the individual's family or carers been notified of this concern?*

YesNo

Is the Lead Safeguarding Officer aware of this referral?*

YesNo

Details of Concern

We kindly request that you complete all sections regarding your safeguarding concern.

Date Occurred*

Date

Time Occurred*

:HourMinutesAM/PM Option

Club Name:*

Describe your concern:*

Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.

Witnesses or Supporting Accounts:*

Please provide details of any one who has shared your concerns or witnessed any incident: Name, Position within the sport or relationship to the individual concerned, DOB, Address, Postcode, Telephone Number, Email Address

Conflicts of Interest:*

Do you have any relationship with anyone involved in this case which could cause a conflict of interest in any investigations? If yes, please describe your relationship

Signature*