Safeguarding Concern Report Form

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 NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Organisation of the Person Flagging Concern*

Scottish ArcheryClubAreaOther
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 NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Additional Support Needs*
- Victim 2
- Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Email
  example@example.com
- Additional Support Needs
- Victim 3
- Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Email
  example@example.com
- Additional Support Needs
- Victim 4
- Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Email
  example@example.com
- Additional Support Needs
- 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?
  
  YesNo
- 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 NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Victim
  
  FatherMotherGrandparentGuardian/CarerCoachClub MemberNo RelationshipUnknownOther
- SOC 2
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Victim
  
  FatherMotherGrandparentGuardian/CarerCoachClub MemberNo RelationshipUnknownOther
- SOC 3
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Victim
  
  FatherMotherGrandparentGuardian/CarerCoachClub MemberNo RelationshipUnknownOther
- SOC 4
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Victim
  
  FatherMotherGrandparentGuardian/CarerCoachClub MemberNo RelationshipUnknownOther
- Details of Concern
- Witnesses
- Were there any witnesses?
  
  YesNo
- Witness 1
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Organisation of Witness
  
  Scottish ArcheryClubAreaOther
- Name of Club/Area/Other organisation
- Role
- Witness 2
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Organisation of Witness
  
  Scottish ArcheryClubAreaOther
- Name of Club/Area/Other organisation
- Role
- Witness 3
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Organisation of Witness
  
  Scottish ArcheryClubAreaOther
- Name of Club/Area/Other organisation
- Role
- Witness 4
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Organisation of Witness
  
  Scottish ArcheryClubAreaOther
- Name of Club/Area/Other organisation
- Role
- 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*
  
  MonthDayYear
  Date
- Should be Empty:

Safeguarding Concern Report Form

1. About the Person Raising the Concern

2. Details of the Concern

About the Individual(s) potentially at risk ('victim')

Victim 1

Victim 2

Victim 3

Victim 4

About the Subject(s) of Concern (SOC)

SOC 1

SOC 2

SOC 3

SOC 4

Witnesses

Witness 1

Witness 2

Witness 3

Witness 4

3. Submission Confirmation

Reporting the Concern

Confirmation