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: