Your details
Please complete all sections.
About the person or people you are concerned about or involved in the incident
When reporting a concern involving a child (anyone under the age of 18), please complete all sections.
When reporting a concern about an adult, the parent / carer details may not be required.
Whenever these details are recorded, please also include their relationship to the person involved.
Details of the incident/disclosure/concern
Please include as much relevant detail as you can.
When reporting a disclosure, please quote the individual word for word where possible.
Please also comment on their body language or any other non-verbal communication that might be useful.
When drawing conclusions, please include the evidence that has led to that conclusion.
Action taken advice sought
Please provide details. If no action was required, please indicate by writing ‘None’
If any advice was sought, please provide details including who you spoke to, their contact details and what advice was given or action that was taken.
Anything else?
Please add anything else you believe will be useful or we should know
