Child Safety Informal Report

Use this form if you think something is not quite right – if things feel a bit off. We can help you worth through it.

This form will be kept confidential. If something more serious happens and we need to take action we will tell you first. Do you understand this?(Required)

Yes

Details | Please provide some contact details in case we need to talk to you.

Name

First Last

Phone

Date of the incident that concerned you?

Email Address

What happened?

Detail as many facts about what happened (or is happening) here. What did you see/hear/feel to make you think something is wrong?

If this report is about you, what do you think should happen to fix the problem?

Is there any other information you can provide e.g did anyone else see it happen? Can we talk to that person?