Child protection: incident report form
Details of person
making the report:
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Name
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Date
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Title/Position
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Organisation name
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Contact numbers:
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Mobile
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Home
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Work
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Address
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Email address
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Details of child
affected:
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Name
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Date of birth
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Contact numbers:
(If same as for parent/guardian, use section
below)
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Mobile
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Home
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Work
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Address
(If same as for parent/guardian, use section
below)
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Details of
parent/guardian:
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Name
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Relationship to child
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Contact numbers:
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Mobile
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Home
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Work
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Address
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Details of adult
of concern (person who complaint/concern is about):
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Name
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Date of birth
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Contact numbers:
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Mobile
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Home
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Work
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Address
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Please include a summary of the incident/concerns
below. Please describe any action that has been taken already.
Relevant paperwork and additional sheets should be
indicated in the boxes provided and sent to LTA Child Protection with this
form.
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Number of additional sheets attached:
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Other
agencies/organisations/individuals informed:
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Contact 1
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Name and address of organisation/individual
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Telephone number
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Contact person/reference number
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Contact 2
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Name and address of organisation/individual
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Telephone number
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Contact person/reference number
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When you have completed the form:
Attach any background
documents and send the form to the LTA Child Protection Department by email or
post.
Remember to telephone the
Child Protection Department directly if you need advice quickly.
If you believe that
someone may be at immediate risk, you should contact your local police or
social services department. Dial 999 if there is an emergency.
Apart from the police or
social services, you should not discuss this referral with anyone before taking
advice from your county or LTA Child Protection officer.
LTA Child
Protection
T: 0208 487 7008/7116
M (24 hour): 07971 141 024
F: 0208 487 7301
E: childprotection@lta.org.uk
www.LTA.org.uk/childprotection