YOAC Safeguarding/Welfare Report Form

YOAC Safeguarding/Welfare Report Form
Please complete the form below which will be automatically sent to our club welfare officers and secretary on submission.

Safeguarding Concerns

If you think a child, young person or adult is at risk of significant harm or abuse, or require urgent protection, call the Police on 999 and/or your local Social Services.

If the matter is not immediate, please speak to a club welfare officer Steve Faulkner, Sue Groves or Fiona Knight. Contact details can be found on the YOAC Website or contact a member of the EA Welfare Team by calling 07464 522426.

In either circumstance, please also complete the EA Safeguarding Incident form. if you have a concern.
Date*

DayMonthYear
Name of member*

First NameLast Name
Date of birth*

DayMonthYear
Date
YesNo
YesNo
Parents Name

First NameLast Name
Parents contact number

Area CodePhone Number
Parents Email
example@example.com
Investigated/Report completed by Name*

First NameLast Name
Date of incident*

DayMonthYear
Approximate time of incident

:HourMinutesAM/PM Option
Location*
Where (actual location of incident)
Description of incident or concern*
Any other notes/outcomes
Witnesses (if relevant, were there any and if so do you have names/ statements?)
Witness/Witnesses Names
Should be Empty: