Make a safeguarding referral

You can use this form to let us know your concerns about a child or young person

Our Privacy Statement explains more about how we use the data you give us on this form.
Overview

This form can be completed by members of the public, parents/carers and, professionals. To enable us to process your referral without delay, please complete this form fully in as much detail as possible. All questions marked as mandatory * must be completed.
Information you will need
1. You can save this form and come back to it. Please have ready as much information as possible when making a safeguarding referral. The information required includes but is not limited to:
  - Child's full name, postcode, date of birth or due date, and the name of their school
  - Parent/carer's full name and address (if different from the child's), and their contact details
  - Details of your reason for referral, including the impact on the child/young person, what works well for the family, and what type of support you think the family would benefit from
1. Do you have an immediate concern for the child's safety?*
  Does the child have an injury which is NON accidental, has the child made a disclosure of harm or do you feel there is an immediate risk to the child?
  
  Yes
  
  No
1. If you have an immediate concern for the child's safety, and you are a professional, please contact Children's Services 01635 503190 or if you're a member of the public, please contact Children's Services on 01635503090. If you are referring out of hours, contact the Emergency Duty Team on 01344 351999. If the child is at immediate risk of harm, contact the Police emergency number 999.
2. Do you have a safeguarding concern for this child?*
  If you're unsure and want more information on what a Safeguarding threshold or Early Response threshold is, click here
  
  Yes
  
  No
1. Can you confirm that you have gained parental agreement?*
  
  Yes
  
  No
2. If no, please tell us why.
3. If you feel that informing parent/carer will place a child at risk, please submit the form without agreement/permission.

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Make a safeguarding referral

Overview

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