Doc 3 – Safeguarding reporting form

IRISH 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 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:
Name:
Contact number:
Other (e.g. NSPCC)
Yes            No
Details of advice received:
Name:
Contact number:
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