• Safeguarding Disclosure

  • Thank you for helping to keep people safe by completing this disclosure form. Disclosure is the process by which people start to share their experiences of abuse with others. This can take the form of physical, emotional or sexual abuse or neglect, or any combination of these. Please try to be as descriptive yet as objective as possible.
  • Who is giving this disclosure?*

  • When a disclosure is made, it is important that the following procedure is followed:

    • Remain calm - the person has decided to disclose to a trusted individual;
    • Use TED (Tell, Explain, Describe) to ask only open questions such as:
      • 'Tell me what happened'
      • 'Please explain what you mean when you say .....'
      • 'Can you describe the person?' or 'Can you describe the place?'

    Under no circumstances should a member of staff or volunteer carry out their own investigation into a disclosure, allegation or suspcion of abuse.

  • Details of the person affected

  • Date of birth:
     - -
    2 digit day, 2 digit month, 4 digit year
  • If date of birth is not known*
  • Regular attender of Citygate Church?*

  • Details of incident

  • Date and time of incident/concern:*
     - -
    2 digit day, 2 digit month, 4 digit year

  • Your details - the person completing the form

  • Body Map - Body

    This form is to be completed at the same time (and attached to/stored with) the completed Incident of Concern form or Injury within the provision form for the same incident/injury.
  • Annotate Image

  • Thank you for filling in the form. 

    A member of the Safeguarding team will respond to you within 3 working days.

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