Doc 3 – Safeguarding reporting form

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: