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Emergency Help
Report a Safeguarding Concern
Name of person completing this form
*
Role/Position
*
Email
*
Phone
*
Person of concern (full name)
*
Name of any other person(s) involved
*
Date and time of incident
Jour
Mois
Année
Heure
:
Heures
Minutes
Location of concern
*
Nature of concern
*
Physical injury/abuse
Emotional wellbeing
Neglect
Online safety concern
Allegation against staff/tutor/volunteer
Other
Describe the concern (facts only – what was seen, heard, or disclosed)
*
Multi choice
Option 1
Option 2
Immediate actions taken
*
Reassured the learner
Reported to safeguarding lead
Contacted emergency services
Recorded concern only
Other
External agencies notified/involved (include date and time notified)
*
Did the individual disclose harm or risk directly?
*
Yes
No
Were any injuries visible?
*
Yes
No
Submit
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