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Redeemer Leeds/Crossway Church:    Safeguarding concern form
This form can be used for recording anything from a vague concern or feeling of unease, to noting something you’ve seen or heard which doesn’t seem quite right. In most instances, this will be a means of making sure church family are followed up pastorally and wouldn’t need any higher level escalation.

If something ever seems more immediately worrying and you think harm may occur without immediate intervention, please contact a member of the Safeguarding Team straight away on safeguarding@redeemerleeds.co.uk.
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Email *
Your information (relating to the person completing this form)
Are you part of  Redeemer Leeds or Crossway Church?
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Your full name *
Your contact number *
Your email address
Your connection to the person/people involved *
Form submission date *
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About the person or people you are concerned about or involved in the incident (complete as much as you can)
Their name/s *
Their address
Their date of birth
Details of the concern/incident (What happened, was said, have you noticed?) *
If an allegation, details of the person accused (Please provide as much information as possible or necessary to identify them)
Context of the concern/incident (Where/when/who else was present. Did anyone else witness this with you?) *
Date of concern/incident *
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Time of concern/incident *
Time
:
Immediate action taken to ensure immediate safety (if applicable)
Other action taken or advice sought
Signature (please type your name) *
Should you require any further contact please email the Safeguarding Team, safeguarding@redeemerleeds.co.uk.
A copy of your responses will be emailed to the address you provided.
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