child safeguarding report form

Child 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. TRY AND FILL FORM OUT AT THE TIME OF THE INCIDENT WHERE POSSIBLE. PLEASE ENSURE A COPY OF YOUR COMPLETED REPORT IS SENT TO THE DESIGNATED SAFEGUARDING OFFICER, DEPUTY DESIGNATED SAFEGUARDING OFFICER OR SAFEGUARDING LEAD (if you can’t find their details you can email it to safeguarding@akt.org.uk).

Date(Required)

Time(Required)

Name of person reporting(Required)

First Last

Position at akt(Required)

Email address of person reporting:(Required)

Child's details

Name of child(Required)

First Last

Address of child(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of birth(Required)

Child's contact details(Required)

Details of child's parents/carer/guardians

Name of person 1(Required)

First Last

Name of person 2 (if applicable)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact details(Required)

Reason/s for report including names and details where known. What are you worried about?(Required)

Details of alleged perpetrator(s)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are they also known to akt?(Required)

Action/s taken by the person reporting(Required)

Is the child aware of your concerns and action taken?(Required)

Who else has been made aware of these issues?(Required)

This field is hidden when viewing the form

Report received by akt DSO/Deputy DSO/Safeguarding lead:

Name

First Last

Date