Making a safeguarding referral
This form should only be used to make a referral about a vulnerable adult where you believe that abuse has happened, or is likely to happen.
Please use this form for less urgent referrals only. If you feel the person is in immediate danger please call Safeguarding Team on 01753 475111 rather than completing this form, or dial 999 in an emergency.
Before submitting this form you should try to get the person's consent, however this is not essential.
Professional referrers
If you would like to discuss whether the situation you are concerned about should be the subject of a safeguarding referral, please contact the Safeguarding Team on 01753 475111.
What will I need to complete this form?
You will be required to create a portal account, or log into an existing account, in order to complete and submit this form.
The form will ask you information about:
The person you are referring
Your details
Details of alleged abused/suspect (please see notes for further guidance)
Your concerns
If you are raising a concern about an organisation:
Please use the following for mandatory
fields:
First Name : "Organisation"
Last name : Name of Organisation e.g. "Sunny Days"
DOB: 01-01-1900
Gender: Unknown
Ethnicity: Information not yet obtained
How long will it take?
The form takes approximately 10-15 minutes to complete depending on the amount of information you need to provide. Questions marked * have to be completed before the form can be submitted.
Please be aware that for security reason, your session will timeout after 20 minutes of inactivity. Please save your form regularly using the 'Save for Later' button at the bottom of the screen. The form will then be available for 30 days in the My Saved Forms area of the portal.
Saving a copy of the form
Once you have submitted the form you will be able to see a copy in the ‘My Submitted Forms' section of the portal for 30 days, after this the form will no longer be visible from the portal.
To print the form, or save a copy locally, use the 'Print' or 'PDF' buttons at the bottom of the screen before submitting.