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Safeguarding Incident Report

Report An Incident

Please complete this form fully, and where possible in conjunction with the individual who the concern is about.

Remember consent must be respected unless:

  • Sharing will prevent a crime or a crime has been committed
  • There is a risk to others ‘wider public interest’
  • Alleged perpetrator has care and support needs
  • There is risk to life
  • There is coercion/duress/threats
  • There is a legal requirement to share information
  • A member of staff is implicated

    Your name.

    Your position.

    Your email address (for a confirmation of delivery receipt).

    What is the age group of the vulnerable person concerned?

    Please indicate if you have been given the child's consent.

    Do you have the consent of the vulnerable adults.

    Do you believe the individual has the mental capacity to use and understand information to make a decision and be able to communicate and decision made?

    Child/vulnerable adult’s name.

    Child/vulnerable adult’s DOB.

    Child/vulnerable adult’s address.

    Parent/carers names and address.

    Date and time of any/alleged incident.

    Exactly what the child/vulnerable adult said and what you said. Do not lead or prompt, records must be accurate and factual.

    Action taken so far.

    Details of any witness to incident/conversation including names.

    Your observations of signs/symptoms.

    External agencies contacted. If you select YES to any of the following, you will be prompted to supply a date/time and any further details.

    Police

    Please provide the date/time of the contact, any names with contact details and any advice given.

    Social Services

    Local Authorities

    Please provide the date/time of the contact, any names with contact details.

    Other Agencies (eg. NSPCC)

    Please provide the date/time of the contact, any names with contact details.