Safeguarding Referral Enquiry || Forum Apprenticeships

Safeguarding Referral Enquiry

This form is to be used to notify the DSL of suspected or instances of abuse or neglect and is the start of a Safeguarding Adults (Section 42) Enquiry under the Care Act 2014

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1/3Please fill with your details

Fullname *

Organisation *

Job title *

Type of service *

Email *

Phone Number *

Date *

2/3Adult or Child at Risk

Name *

Date of Birth *

Phone Number *

Ethnicity *

Address *

Email *

3/3Reason for Referral Care & Support

What is the primary reason for the referral care and support? *

Any other details about the referral at risk *

Views, and desired outcomes of the adult / representative *

Has the Referral at Risk given consent for this concern to be raised? *

IMPORTANT

Immediate Actions Taken To Safeguard those at Risk - Immediate risk of abuse or neglect? In an emergency, call the Police on 999.

If you think there has been a crime, but it is not an emergency, call the Police on 101 *

Description of the alleged incident *