Safeguarding
Concerns/Disclosures
1. Enter Your Name *
2. Date *
3. Name of Child, Young Person or Adult the concern is about *
4. Date and Time of incident or when concern was observed *
5. Place where the alleged abuse or harm occurred *
6. Name of any other person(s) present *
7. Details of Concern/Disclosure (include exact words spoken by the Child, Young Person or Adult at risk) *
8. Description of any injuries observed *
9. Was a body map completed? *
Yes
No
10. Any other details *
submit
