WHITEFRIARS CHURCH:

SAFEGUARDING REPORTING FORM

 

 

Name of Person _________________________________________________

 

Date of Concern _________________________________________________

 

Name of Person Completing Form _________________________________

 

 

Age/DoB _________________________________

 

Time ____________________________________

 

Signature _________________________________

 

Reason for Concern (including what the person said – use exact words)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demeanour/Behaviour of Person (please comment)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form passed on to ____________________________________________________________________________________________

 

Discussed with _______________________________________________________________________________________________

 

 

 

Action Taken:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Further Notes:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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