Example from a local authority
Essex County Council has a template for the report of a concern for child protection. It includes space to record details such as:
- The date of both the record and the incident
- The name and role of the person making the referral
- Details of the concern, using a body map if appropriate (you can download a body map template at the link above)
- Action taken and advice sought
- Whether a referral was made
Examples from schools
Primary school
Heathfield Schools' Partnership in Middlesex has a cause for concern form template which covers:
- An outline of the concern
- The context surrounding the incident (such as when it took place, where, and who else was present)
- The follow-up action (to be completed by the DSL)
Secondary school
Henry Cort Community College in Hampshire has a safeguarding concern form on its website.
Whether the child's parents or carers are aware that a report is being made Details