Safeguarding and Child Protection referral form

SectionDetails clearly documented
Date and time of incident 
Name and position of person about whom report, complaint or allegation is made 
Name and age of child involved 

Nature of incident, complaint or allegation

(continue on separate page if necessary.

 

Action taken

(continue on separate page if necessary)

 
If Police or Children’s Social Care Services contacted, name, position and telephone number of person handling case 
Name, organisation and position of person completing form 
Contact telephone number 
Signature of person completing form 
Date and time form completed 
Name and position of organisation’s child protection/welfare officer or person in charge (if different from above) 
Contact telephone number 

Safeguarding and Child Protection referral form in doc format SafeguardingReferral

This form should be copied, marked ‘Private and Confidential’, to the RYA Safeguarding Manager, Jackie Reid, RYA House, Ensign Way, Hamble, Southampton, SO31 4YA, e-mail jackie.reid@rya.org.uk and to the statutory authorities (if they have been informed of the incident) within 48 hours of the incident.

 

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