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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

MM slash DD slash YYYY
Name of person reporting(Required)

Child's details

Name of child(Required)
Address of child(Required)
MM slash DD slash YYYY

Details of child's parents/carer/guardians

Name of person 1(Required)
Name of person 2 (if applicable)

Details of alleged perpetrator(s)


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

MM slash DD slash YYYY