Reporting a Safeguarding Concern

When to use this form

Please use this form to report safeguarding concerns to us that are not urgent.

If you believe that a child is in immediate danger, call the Police immediately on 999. If it is not urgent, complete and submit this form which will be sent to our safeguarding team.

Please provide as much information as you can, so that we have a full understanding of the child’s circumstances and can respond promptly.

DETAILS OF PERSON REPORTING THE SAFEGUARDING CONCERN

Name of person who is reporting the concern* Address* Contact number* Email* Please answer the following*

	Yes	No
Are the child's parent(s)/carer(s) aware that you are reporting your concern?
Has the child’s parent(s) / carer(s) consent been obtained?
Has consent been given for information sharing?*

*If not, please explain why:

DETAILS ABOUT THE CONCERN

Name of Child(ren)* Please explain the concern you have about the child/ren. Please explain the arrangements to keep the child/ren safe? Where is/are the child/ren at present?*

*As the person reporting this safeguarding concern, I confirm that the information I have provided is accurate, to the best of my knowledge.