Report a Concern 

This form is to be used if you have any safeguarding concerns about someone within our church, this could be a disclosure made to you or an observation made.
If the person you are concerned about is in immediate harm please contact 999 then phone the safeguarding lead (contact details are on the Safeguarding Policy -Page 10). Then complete this form.

Your Details
Name:
Email Address:
Telephone:

The Person Involved
Date of Concern
Their Date of Birth or Age         
Is the person a Child or Adult?
If this concern was   
Details of your Concern:
Record the following factually:
Nature of concern, e.g. disclosure, change in behaviour, demeanour, appearance, injury, witnesses etc. (please include as much detail in this section as possible. Remember – the quality of your information will inform the level of intervention initiated.)