Safeguarding Concern Reporting Form - Students and Staff
This form is for the reporting of a safeguarding concern only.

Please note staff filling out this form should be Safeguarding Officers only. All other staff should report the safeguarding concern to the Safeguarding Officer in their area.

Names of Safeguarding Officers can be found at;
http://www.londonmet.ac.uk/about/policies/safeguarding/

Please do not make or keep a copy of this form.

Email address *
Name of Person Making Report *
Your answer
Telephone *
Your answer
Name of Student Involved *
Your answer
ID Number of Student Involved
Your answer
Address of Student (if known)
Your answer
Date of Birth of Student if known (if known)
Your answer
Date of Incident / Disclosure / Allegation *
MM
/
DD
/
YYYY
Time of Incident / Disclosure / Allegation *
Time
:
Name of Complainant *
Your answer
Description of the safeguarding concern (see policy / guidelines at http://www.londonmet.ac.uk/about/policies/safeguarding/). *
Your answer
Which category do you feel the safeguarding concern falls into? Please select one category (main reason) *
Which other categories do you feel the safeguarding concern falls into?
Action taken in relation to the safeguarding concern *
Your answer
Safeguarding concern Has Been Discussed With *
Required
Where concerns have been discussed please state names of those discussed with *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of London Metropolitan University - Staff. Report Abuse - Terms of Service