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:

Irish Bowling Association