Safeguarding Incident Report Forms

The form submitted by

About the child

About the child’s parents:

Details of the incident or concerns

Are you reporting your own concerns or responding to concerns raised by someone else: *

If responding to concerns raised by someone else:

Details of any witnesses to the incident

Involved or alleged persons

External reporting details

Has the incident been reported to any external agencies? *

If YES please provide further details:

If NO please provide the reason: