Safeguarding Incident Referral Form

This form should be used to record any safeguarding or welfare incident or concern that is brought to your attention. Details should be recorded as soon and as accurately as possible. 

Remember to maintain confidentiality on a need to know basis. Only disclose information if it will protect the child. 

All fields are required unless otherwise stated.

Your details

Please complete your details as best you can

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Optional. If you don't know then leave blank

Are you reporting your own concerns or responding to concerns raised by someone else?

Optional. My own concerns

Optional. Name, email, position in club and contact number if possible

Details of the person the concern is attributed to

Please provide details below

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Have they been notified of the allegation against them? NB. This should only happen in a case of poor practice, not in a case of suspected child abuse

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Details of complainant

Please provide details below

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Have the parents/carers been notified of the incident? (if applicable)

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Details of the incident

Please provide as much information as possible

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Optional. Name, number, date, details of advice

Verification

Please click the box to indicate you are a human rather than an automated system completing this form.

Last step

Please ensure all fields are completed as accurately as possible before submitted.