Safeguarding and Welfare Reporting Form

Please complete the following sections with as much detail about the specific safeguarding/welfare concern or allegation as soon as possible. Nene Park Trust Safeguarding Team will contact you within 48 hours of receiving the referral.

However, if a child or adult is in immediate danger or a crime has been committed, please contact the police 999, Social Care Services Cambridgeshire & Peterborough / NSPCC

To keep children and adults safe, information may need to be shared appropriately with other organisations. However, confidentiality will be maintained where appropriate to ensure that only those who need the information are made aware of it.

If you have any queries or concerns about the information you are providing, please contact Nene Park Trust Safeguarding team at safeguarding@nenepark.co.uk.

Your details / details of person reporting:

Name:*

First NameLast Name

Contact Phone Number:*

Email Address:*

example@example.com

Role of person reporting (to be filled in by Nene Park Trust staff only)

Details of the alleged victim (if known):

Name

First NameLast Name

Adult 18+Child

Date of Birth / Approximate Age:

Contact Phone Number:

Email Address:

example@example.com

Address:

Street Address

Street Address Line 2

CityCounty

Post Code

Details of the person you are reporting (if known)

Name

First NameLast Name

Adult 18+Child

Date of birth / approximate age:

Contact Phone Number:

Email Address:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Details of incident or concern:

Date incident / concern occurred:*

Time incident / concern occurred:*

Include all relevant information, such as a detailed description of your concerns and reasons for these. Please describe any steps you have already initiated:*

Thank you for your time to complete this form.