adult safeguarding report form

Adult safeguarding report form

This form should only be completed by those who do not have access to In-Form whenever an issue or concern has arisen that needs reporting regarding a child or adult. PLEASE ENSURE A COPY OF YOUR COMPLETED REPORT IS SENT TO THE DESIGNATED SAFEGUARDING OFFICER OR DEPUTY DESIGNATED SAFEGUARDING OFFICER (if you can’t find their details you can email it to

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Name of person reporting(Required)
Email details of person reporting(Required)

Adult's details

Name of adult(Required)
Address of adult(Required)
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Details of alleged perpetrator (s)


Report received by akt DSO/Deputy DSO/Safeguarding lead

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