Safeguarding Concern Report Form
This form must be completed as soon as there is a concern about the safeguarding or protection of a Scottish Archery member or someone at a Scottish Archery event. This form, once completed, will be sent to Scottish Archery's Child Protection Officer for further processing.
1. About the Person Raising the Concern
Please complete a few basic details about the individual who is raising the concern
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Organisation of the Person Flagging Concern
*
Scottish Archery
Club
Area
Other
Name of Club/Area/Organisation
*
Role
*
What role does this person have in this organisation?
2. Details of the Concern
Are you raising a concern about an individual (or individuals) who may potentially be at risk (referred to as 'victim')
About the Individual(s) potentially at risk ('victim')
Please complete a few basic details about the individual(s) who you think may potentially be at risk
Victim 1
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Additional Support Needs
*
Click here to register another victim
Victim 2
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Additional Support Needs
Click here to register another victim
Victim 3
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Additional Support Needs
Click here to register another victim
Victim 4
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Additional Support Needs
SUBJECTS OF CONCERN
You have identified that an individual may be at harm ('victim') - is there an individual ('Subject of Concern' or SOC) you wish to raise a concern about as potentially being responsible for causing harm?
Yes
No
About the Subject(s) of Concern (SOC)
Please complete a few basic details about the person whom there is potentially a concern over as the person potentially causing harm
SOC 1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Victim
Father
Mother
Grandparent
Guardian/Carer
Coach
Club Member
No Relationship
Unknown
Other
Click here to register another subject
SOC 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Victim
Father
Mother
Grandparent
Guardian/Carer
Coach
Club Member
No Relationship
Unknown
Other
Click here to register another subject
SOC 3
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Victim
Father
Mother
Grandparent
Guardian/Carer
Coach
Club Member
No Relationship
Unknown
Other
Click here to register another subject
SOC 4
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Relationship to Victim
Father
Mother
Grandparent
Guardian/Carer
Coach
Club Member
No Relationship
Unknown
Other
Details of Concern
WITNESSES
Witnesses
Were there any witnesses?
Yes
No
Witness 1
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Organisation of Witness
Scottish Archery
Club
Area
Other
Name of Club/Area/Other organisation
Role
Click here to register another witness
Witness 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Organisation of Witness
Scottish Archery
Club
Area
Other
Name of Club/Area/Other organisation
Role
Click here to register another witness
Witness 3
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Organisation of Witness
Scottish Archery
Club
Area
Other
Name of Club/Area/Other organisation
Role
Click here to register another witness
Witness 4
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Organisation of Witness
Scottish Archery
Club
Area
Other
Name of Club/Area/Other organisation
Role
SUBMISSION CONFIRMATION
3. Submission Confirmation
Reporting the Concern
Please sign and date the form below to confirm that the information provided is accurate to the best of your understanding and that you will support Scottish Archery with any further investigation as considered necessary.
Confirmation
Agreement 1
*
I confirm that the information provided is accurate to the best of my understanding
Agreement 2
*
I confirm that I will support Scottish Archery with any further investigation as considered necessary
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: