Safeguarding or Welfare Incident Form

Use of this form

This form should be used to report any safeguarding or welfare incidents

All relevant sections of the form must be completed.

Remember, have you?

Reassured the young person / adult at risk
Been honest and not made promises you cannot keep
Explained why you may have to tell other people in order to stop what’s happening
Avoided closed questions and asked as few a questions as possible
Encouraged the child to use their own words
Asked if they have made a parent aware of their concern

Please remember you also have a duty to report all Serious Incidents (such as discrimination online or offline, and abuse against match officials) to [email protected]

NOTE

When you have completed this form and press the submit button, you will be progressed to a page titled "Thank you for your submission."

If you press the submit button and this doesn't happen, scroll back up through the form again and look for any sections that you may have missed/not answered.

You will not be able to submit this form unless all mandatory fields have been completed.

Contact BE's Integrity Department

Safeguarding or Welfare Incident Form

1) General information

ABOUT THE PERSON FILLING IN THIS FORM - Your name: *

Your role within team: *

Your phone number: *

Your email: *

Your signature: *

Description of Activity/Trip: *

Medinotes URN of player or name of any individuals affected:

2) Details of the person who reported the concern/incident to you (if applicable)

Name:

Role in team:

Their phone number:

Their email address:

3) Details of the child/adult at risk

Name:

Team:

Date of birth (if known):

Any other relevant information about the child e.g. disability, ethnicity etc:

4) Further information

Date of any incident:

Time of incident (if known):

Your observations:

Exactly what the child/adult at risk said:

Action taken so far:

Name & contact details of any witness(es):

DON'T FORGET

When you have completed this form and press the submit button above, you will be progressed to a page titled "Thank you for your submission."

If you press the submit button and this doesn't happen, scroll back up through the form again and look for any sections that you may have missed/not answered.