Doc 3 – Safeguarding reporting form

IRISH WOMEN’S INDOOR BOWLING ASSOCIATION SAFEGUARDING REPORTING FORM

Insert Name of Club

Record completed by:

Position:                                                        Date:

Child/Young Person’s Name:

Child/Young person’s Address:

Persons Date of Birth if under 18:

Parents/Carer’s Names and Address:

Date and time of any incident:                  Date:                               Time:

Your Observations:

Detail exactly what the child/young person said and what you said :

(Remember do not lead the child/vulnerable adult – record actual details. Continue on a separate sheet if necessary)

Action taken so far:

Designated Safeguarding Officer informed?           Yes            No

External Agencies contacted Police                          Yes            No

Branch contacted:                                                           Details of advice received:

Name:

Contact number:

HSCT/Gateway                        Yes             No

Branch contacted:                                                           Details of advice received:

Name:

Contact number:

Irish Women’s Indoor Bowling Association       Yes                 No               Details of advice received:

Name:

Contact number:

Local Council or Education Department (if appropriate) Yes       No

Org name:                                                                                                    Details of advice received:

Name:

Contact number:

Other (e.g. NSPCC)                     Yes      No                                                   Details of advice received:

Name:

Contact number: