Cause for Concern Form

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Do not discuss with anyone else (including parents/guardians and group leaders) except the Safeguarding Leaders.

GUIDANCE NOTES FOR COMPLETING FORM:

What constitutes a safeguarding concern? – anything that has caused you to question the safety or general wellbeing of a child or an adult at risk of harm (e.g. the elderly or an adult with a physical or learning disability), however small.
Why do you need information regarding ‘other household members’? – It is important to include information about significant adults in the household especially when concerns relate to children.
Why is the view of the child/adult significant? It is important to give whatever detail is available of the child or adult’s explanation (or verbatim) of the matter to help ascertain if it is plausible and to help offer a context to the concern identified. You do not need to investigate this if it isn't part of your initial concern.
Passing information to the Safeguarding co-ordinator – Your safeguarding co-ordinator holds ultimate responsibility in responding to any safeguarding concerns within New Community Church and therefore it is important that they have oversight of the actions being taken and make relevant and appropriate contact with statutory agencies if required. They will remain the most appropriate link between the organisation and external agencies.

1. Your Name: *

2. Your Role / Job title *

Child or Adult Concern
*

Child (Select if the concern relates to a child (under 18), a parent/caregiver, or the safety of a household where children live.)

Adult (Select if the concern relates specifically to an adult who is at risk of harm, e.g. the elderly or an adult with a physical or learning disability)

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