Safeguarding Reporting Form

1

In an emergency please do not delay in informing the police or social services. All the information must be treated as confidential and reported to the Designated Safeguarding Officer within one working day or the next working day if it’s a weekend.

The form should be completed at the time or immediately following disclosure, but after all necessary emergency actions have been taken. Please complete the form as fully as possible.

This form, upon submission, will directly go to the Safeguarding Officer.

Privacy Policy

2

Name* This field is required.

First Name

Last Name

3

Position* This field is required.

4

Phone Number* This field is required.

5

Email* This field is required.

example@example.com

6

Name* This field is required.

First Name

Last Name

7

Details of the incident * This field is required.please describe in detail using only the facts

8

Other present or potential witnesses - details

9

Additional relevant informationplease detail anything else that you believe to be helpful or important

10

I have completed this form and provided information that is factual and does not contain my own views or opinions on the matter* This field is required.

I agree

11

Date* This field is required.

Date