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Use this form to record any safeguarding concern, however trivial. On submission it will be immediately emailed to the Designated Safeguarding Lead for Vineyard Community Church. Answer every question.
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If this incident/concern has also been reported on an Incident/Accident Report, attach the Report or provide the Report reference number.
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Are you reporting your own concern or one raised by someone else?
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If you are raising a concern made by someone else, please provide their full name, status and contact details
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Please provide details of the concern you have including dates, times, descriptions of events, full names and whether the information is first hand or the accounts of others
Note: If you have already reported this information on an Incident/ Accident Report, simply write ‘See attached Inc/Acc Report’ or ‘See AssessNET Report’
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The person at risk’s account (if applicable). Include what they want the outcome to be
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Provide details of the person causing harm (if known)
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Provide details of any witnesses to the concern
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Provide details of any previous incidents or concerns relating to this person (if known)
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Note: If you have already reported this information on an Incident/Accident Report, simply write ‘See Inc/Acc Report’ or ‘See AssessNET Report’
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You should only contact people outside Vineyard Community Church to deal with an immediate emergency (for example, police or ambulance service).
Give details below of any people outside Vineyard Community Church that you have communicated this concern to – give name, position, contact details, and the date and time that you contacted them: |
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I have completed all sections of this form to the best of my knowledge
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