safeguarding

everyone

REPORTING A
CONCERN

As followers of Jesus we are keen to follow Him in sharing God’s love and care for everyone that comes into contact with us, particularly children and adults with additional care and support needs.

We want to provide a safe environment in which people can thrive, doing all we can to ensure their well-being and taking a responsibility to safeguard them from any form of abuse.

Everything you report will be dealt with my our Safeguarding Lead, Jamie Forster. We will properly record and report any abuse that we discover or suspect. If you have a concern or incident you wish to disclose to the safeguarding lead, please complete the form below.

All information submitted to us via this form will be stored according to our Data Protection Policy.

Safeguarding concern record

This form contains the necessary information that you must record if a safeguarding concern comes to your attention. Ensure that you complete this form to the best of your ability, as it will help everyone involved in the case to get a full picture of the situation.

Section 1: Your details

Details of person reporting the concern.

Full name:

Phone

Today's date and time

Day

Month

Year

Time

HoursMinutes

Section 2: Details of the person affected

Full name:

Further information: (For example, any care and support needs, a history of abuse or any dependents)

Is the person affected under the age of 18?

Yes

Section 3: Details of the concern.

A disclosure can be verbal or written. It can come directly from the adult affected or by any other person who has witnessed and incident or has seen evidence that indicates abuse or neglect may be occurring.

Full name of person or persons involved:

Date and time of the incident:

Day

Month

Year

Time

HoursMinutes

Location of the incident: (E.g Ministry setting like at a small group, at church event, during a Sunday)

Which setting did this incident take place in?

Is anyone involved under the age of 18?

Yes

Details of the incident including what was said, who was present, what happened:

Do you have a photo of any supporting evidence realting to this incident?

Yes

Section 4: Further information

Further information

Attach any supporting evidence: (You can upload up to 6 items)

I confirm that the information I have included in this form is, to the best of my knowledge, accurate and I hereby give permission for Middlewich Community Church, safeguarding officer to make contact with me on the number provided if further clarification about this incident is required.*:

Please confirm the above statement here:

Yes