Welfare & Safeguarding Incident Report Form
Record welfare and safeguarding situations accurately and clearly.
Basic Details
Date of Incident
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location
*
Job Type
*
Attendant Details
Attendant Name
*
Individual Details
Name (if known)
Approximate Age
Gender
Please Select
Male
Female
Non-binary
Prefer not to say
Other
Description
Reason for Welfare Concern
*
Intoxication
Vulnerability
Injury
Mental Health Concern
Lost Person
Other
Situation Description
*
Actions Taken
*
Assisted to safe place
Monitored
Refused service/entry
Contacted friends/family
Other
Safeguarding Concerns Identified?
*
Yes
No
If yes, provide details
Outcome
*
Left safely
Handed to responsible person
Handed to police
Ambulance called
Refused help
Bodycam Used?
*
Yes
No
If used, was footage saved?
Yes
No
Additional Notes
Submit Report
Should be Empty: