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UNIVERSITY OF SUFFOLK
Reporting a Cause for Concern Form Page 1 of 3
Version: 3.0 (August 2016)
Owner: Academic Registrar
This form should be used to report any cause for concern regarding a University of Suffolk student and forms part
of the Fitness to Practise Procedure. The Fitness to Practise Procedure applies to students enrolled on courses
which lead to professional registration and/or licence to practise and where Disclosure and Barring Service (DBS)
checks are normally required. These courses are likely to involve a practical professional placement as a required
part of the course including, for example, teaching, counseling, nursing, midwifery, radiography and social work.
Students on such courses have additional responsibilities placed upon them regarding their professional suitability,
as outlined in the codes of practice of the relevant Professional, Statutory and Regulatory Body (PSRB). Failure to
meet these requirements may lead to the Fitness to Practise Procedure being invoked.
Concerns about a student’s fitness to practise may be raised from any source, including any member of staff,
student, placement partner, member of the public, the Occupational Health Service or other agencies such as the
Police or Social Services. Normally the allegation will relate to behaviour whilst the student is on the Institution’s
premises or in attendance at a placement setting related to the course. However, if it is reasonably believed that a
student’s behaviour off site has damaged or compromised relevant professional standards, action may be taken
in accordance with this Procedure.
An allegation raising concern about a student’s fitness to practise is a serious and potentially defamatory one.
Consequently all details and proceedings will be conducted on the basis of strict confidentiality.
DETAILS OF INITIATOR OF CONCERN
Full Name
Profession
Role and how you know
the student (e.g. personal
tutor, mentor, practice
education facilitator, fellow
student)
Job Title
Contact Number
Email Address
STUDENT DETAILS
Full Name
Student Number
Student’s Course
REPORTING A CAUSE FOR CONCERN FORM
UNIVERSITY OF SUFFOLK
Reporting a Cause for Concern Form Page 2 of 3
Version: 3.0 (August 2016)
Owner: Academic Registrar
NATURE OF CONCERN
Outline below, in detail, the basis of the concern, what action has been taken to date and list
the evidence attached which supports the basis of the concern.
Is the student aware of
the concern?
YES NO
Is this the first concern
regarding the student?
If no, please provide
details of previous
concerns
YES NO
Has a Safeguarding Lead
been informed?
If so, please provide name
YES NO
Has the Educational Lead
at Trust level or equivalent
for Social Work been
informed?
If so, please provide name
YES NO
UNIVERSITY OF SUFFOLK
Reporting a Cause for Concern Form Page 3 of 3
Version: 3.0 (August 2016)
Owner: Academic Registrar
DECLARATION
I confirm that the information given on this form and in supporting documents is true to the
best of my knowledge and belief.
Signed
Date
Where to submit your form
Once completed, this form and your supporting evidence should be submitted to the Office
for Student Appeals, Complaints and Conduct (OSACC)
Email: osacc@uos.ac.uk
Tel: 01473 338353
Post: Office for Student Appeals, Complaints and Conduct
University of Suffolk
Waterfront Building
Neptune Quay
IPSWICH, IP4 1QJ
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Completed 4 February 2021

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