What is the name of the person filling out this safeguarding concern form?

Who or what is the concern about? *

What is the nature of the concern? Please provide as much detail as possible. *

Has the concern been addressed to a degree thus far? If so, how? Have relevant organisations or social services been engaged? *

Is any follow-up needed? If so, what are your recommendations? As a safeguarding team we have a duty of care to our volunteers and service providers and cannot promise that we will be able to abide by your recommendations, but we would like to know your thoughts. *

Is there any further information to provide? If you would like to send any further evidence to support the safeguarding concern, including screenshots, please email them to kca2safeguarding@gmail.com with clear reference to the concern in the email.

If you consent to the Colville, Norland and Notting Dale Support Network's Safeguarding Team following up with you for any clarification, please leave your phone number and/or email address.

I understand that by submitting this form, I am triggering the Colville, Norland and Notting Dale Support Network's Safeguarding team to follow up the concern and take action, as they deem appropriate. *