Safeguarding Concern

Safeguarding Concern
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1. Details of the Adult at Risk

2. Details of the Concern

Start Time
Type of Concern (tick all that apply):
Please provide a factual account of what was seen, heard, reported or observed.

3. Person Raising The Concern

Which best describes the person raising the concern:

4. Details of Alleged Person Causing Harm (If Known)

5. Immediate Action Taken

Was anyone in immediate danger?
Was emergency assistance required?

6. Consent

Has the adult at risk been informed that this concern is being reported?
Has consent been obtained to share information?