Safeguarding Incident/ Concern Form
This form should be used for reporting any safeguarding incidents that may have occurred or for raising any concerns about a student on The Access Project's wellbeing.

Completing this record should not stand in the way of contacting Police or Social Services in the event of an emergency or urgent safeguarding incident.

Should you have any queries regarding safeguarding at The Access Project, our safeguarding team can be contacted at stayingsafe@theaccessproject.org.uk.
Date of reporting *
MM
/
DD
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YYYY
Name of the Access Project student(s) the incident/ concern relates to *
Student Age *
If you do not have this information, please respond "unsure"
School Year *
If you do not have this information, please respond "unsure"
School the student(s) attend(s) *
If you do not have this information, please respond "unsure"
Reporter's name *
This would be the name of the person completing the form
Reporter's role *
Please specify if you are a Volunteer Tutor, member of TAP staff (please provide your role), student's parent etc.
Reporter's contact details (email address and/or phone number) *
Please add your contact details so we can contact you should we need any further information
Name, role and contact details of the person who raised the concern (if not yourself)
Date the incident occurred/ concern arose *
MM
/
DD
/
YYYY
Time the incident occurred/ concern arose *
Please input as a 24 hour time
Time
:
Where did the incident happen/ concern arise? *
Either physical location or, if it arose as a result of a text or email, please specify this. If it was during a tutorial, please state where the tutorial was held.
Details of any witnesses/ other people involved, including where applicable name, age (if under 18), role and contact details
What happened/ how did the concern arise? *
Please provide as much information as possible, including specific times, dates and locations of events. You should use factual information only - Use exact words spoken if possible. Some things to note could be physical evidence available at the time, such as injuries, the emotional state of the student(s) in question or noted changes in behaviour.
What action has been taken following the incident/ concern? *
Is the student aware at the moment that the concern has been raised/ incident reported? *
(TAP staff only) Have school been made aware of the situation/ concern?
Clear selection
(If yes to the previous question) who in school has been notified? Name(s), role(s), contact details.
If any external agencies have been notified (such as police, social services, Local Authority or NSPCC), please provide details about this.
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