Child protection concern forms

Take a look at example safeguarding forms for recording child protection concerns and disclosures, from a local authority and schools. Plus, find a template spreadsheet you can download and use to track concerns and referrals in your school.

Last reviewed on 23 September 2021
School types: All · School phases: All
Ref: 2589
  1. Example from a local authority
  2. Examples from schools
  3. Track the progress of child protection concerns

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