Safeguarding Concern Form 
Concerns, suspected harm, or disclosure of a child at risk of harm, must be reported within 24 hours to the Safeguarding Lead by FIA staff members and volunteers. Others (parents, students, community members, visitors, alumni, etc.) may also use this form to report. In addition this form can also be used to share historical allegations, 

Please fill out this form to the best of your ability. If you do not know the answer to a question please just leave that section blank. Please contact FIA's Safeguarding Lead at safeguarding@fia.edu.ph if you have any questions, concerns or other information. 

Once the Safeguarding Lead receives this form he or she will contact you to acknowledge that. 
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Email *
Your name *
Your contact details (email/phone number)  *
Name of child harmed or at risk
Gender/Age/Grade 
Brief description of what prompted concerns *
Details of what was disclosed, observed or suspected 
Are there any immediate concerns about this issue?  *
Have you consulted or spoken to anyone else about this?  *
Are there others that we should contact about this? 
Additional Information 
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