Notication of Safeguarding Concern
For those completing this form (not HQ Safeguarding team) please complete section 1, 2, 3, 4.
This section to be completed by Girlguiding HQ
Date Incident Reported: Case Reference:
Duty Ofcer: Case Manager:
1. NOTIFICATION DETAILS:
Name of person notifying:
Membership No. (if applicable): Role:
Phone number: Email:
Position: LADO Police Public Social Services Volunteer Parent
2. DETAILS OF THE PERSON AGAINST WHOM ALLEGATIONS HAVE BEEN RAISED:
Name: DOB:
Membership No: DBS end date, if known:
Address:
Unit: County:
Region:
To be completed by Girlguiding HQ
Date Suspended: Date suspension letter sent:
Safeguarding
3. DETAILS OF THE CHILD/VULNERABLE ADULT POTENTIALLY HARMED:
Name: DOB:
Membership No:
Address:
Unit: County:
Region:
Does parent/carer know about the concern: Yes No
© Girlguiding 2018 www.girlguiding.org.uk
Volunteer Report Form - Safeguarding Concern
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4. BRIEF OVERVIEW OF CONCERN:
© Girlguiding 2018 www.girlguiding.org.uk
Volunteer Report Form - Safeguarding Concern
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Sections 5-7 are to be completed by the HQ Safeguarding Team
5. CONTACTS (NAME AND NUMBER):
REGION CHIEF Name:
Email: Phone:
COUNTY COMMISSIONER Name:
Email: Phone:
REGION SG VOLUNTEER Name/s:
Email: Phone:
LADO Name:
Email: Phone:
CHILDREN AND FAMILY SERVICES Name:
Email: Phone:
POLICE Name:
Email: Phone:
DATE ACTION BY ACTIONS
© Girlguiding 2018 www.girlguiding.org.uk
Volunteer Report Form - Safeguarding Concern
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6. FINAL OUTCOME OF INVESTIGATION:
Outcome: No action required Restriction Withdrawal Refusal
Please provide detail for the outcome:
7. CLOSING CHECKLIST
Date Suspension lifted: Date referrer notied of outcome:
Date Commissioner notied:
Date notication sent to individual concerned:
Date withdrawal, restriction, refusal paperwork processed:
Date Go amended with outcome:
DBS Referral: Yes No Date completed:
© Girlguiding 2018 www.girlguiding.org.uk
Volunteer Report Form - Safeguarding Concern
4
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