Safeguarding Report Form

SAFEGUARDING REPORT FORM

Guidance for Raising and Reporting Concerns

Use this form to raise and report any concerns you have which are relevant to an individual who is in contact with YARDO CIC (including staff and volunteers), or anyone who is associated with this individual.

You may also use this form to raise a concern about the conduct of a member of YARDO staff or a volunteer.

If you cannot or do not wish to answer a particular question, please use 'N/A' instead of leaving blank spaces.

Please complete as soon as possible after the concerning incident or observation.

Your Name

Phone

Please provide details, including whether your concern arsises from direct observation or third party information.

Date of incident or observation

Location of incident or observation

Please provide details of any action you have taken, including anyone you have informed, eg a member of YARDO's staff or your supervisor.

Thanks for submitting!