This form should be used to record safeguarding concerns relating to Children, Young People and/or Vulnerable Adults. All the information must be treated as confidential and reported to the Designated Safeguarding Officer within one working day, or the next working day if it’s a weekend. The form should be completed at the time or immediately following disclosure. Please complete the form as fully as possible. In an emergency please do not delay in informing the police or social services. 

1. Your details (person completing the form)
2. Details of the person affected
3. Account of the disclosure / incident (please transcribe in detail using only the facts)
Additional relevant information

Eg: 

  1. Any visible injuries if applicable 
  2. Details of any action you have taken eg informed a teacher, contacted NSPCC etc.
I have completed this form and provided information that is factual and does not contain my own views or opinions on the matter.