Safeguarding Form

View Guide to Managing a Disclosure of Child Abuse View Child Protection Policy

Safeguarding Form

This is for Safeguarding concerns only where you believe a child's safety is at risk. For general behaviour issues please complete the Incident Form.
Child's Full Name

First NameLast Name
Child's Age
Child's Gender
School
Club

Breakfast ClubAfter-School ClubHoliday CampExtra-Curriculumn Club
Have you verbally spoken to the parent's regarding concerns?

YesNo
Please state your reason for concern.
Voice of the child - If you have had a conversation with the child or they have disclosed information of concern, please state exactly what the child said. Remember to write the exact words the child used and not your interpretation of what they meant.
Timeline - If your concern involves a number of incidents please explain the timeline of what has happened and when.
Action Taken? Include: Safeguard form completed, any first aid treatment or medical assistance found in relation to safeguarding incident, call to lead safeguarding officer, spoken to parent, discussion with school etc.
Witnesses/People involved - If there are any other people that have witnessed the incident or involved in any way please state their full name, position and or relationship to the child and how they are involved.
Form completed by
2nd Get Active Staff Member Witness Form Confirmation

YesNo
Data Protection Act 1998: Any information provided will be used within the guidelines outlined in the “Framework for the Assessment of Children in Need and their Families” and “Working Together”. It will be treated in strict confidence and only disclosed as necessary and to any extent appropriate and as required by law or to safeguard a child in the public interest.

Where information is disclosed to other agencies it will be subject to the provisions of the Multi-Agency Disclosure Protocol.

Details may be shared with the family of the child as necessary to safeguard the child and for the assessment process.
Should be Empty:

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