Report a Safeguarding Issue 

Safeguarding Concern Form

If it is an emergency situation and you believe a child, young person or adult is in immediate danger of significant harm call 999 IMMEDIATELY before reporting on this form. 
If this concern form needs immediate attention – please email the Safeguarding Officers safeguarding@stpaulscamb.co.uk  straight away, as well as completing this report. 

Please use the form below to report a safeguarding disclosure or concern.

1. This concern/disclosure is in relation to
 Child/Young PersonVulnerable adult

2. Name of the child/vulnerable adult


3. Age of the child/vulnerable adult

4. Address and contact number of the child/vulnerable adult

Address:
Town:
County:
Postcode:
Country:

5. Details of any persons suspected of any neglect and/or abuse (name, age, address if known)

6. When did you become aware of the concern?

7. Details of the concern. Include dates, times, places and names of all those involved

8. Is the child/adult aware that you are sharing this information?
YesNo

9. If the concern is in relation to a child, is the parent/carer aware that you are sharing this information?
YesNoAdult

10. Enter your name and contact details

Name:

Email Address:

Telephone:
Mobile: