SAFEGUARDING

SAFEGUARDING CONCERN | INCIDENT REPORTING FORM

If you believe a child is in immediate danger or imminent risk of harm please contact 999.

Your Name

Your Role

Contact Information (you):

Your Address

Telephone Numbers

Your Postcode

Your Email address

Child's Name

Child's Date of Birth

Child's Ethnic Origin

Does child have a Disability?

Child's Gender

Male Female

Parent's/Carers' Name(s)

Contact information (Parents/Carers)

Address

Telephone Numbers

Postcode

Email Address

Have parent’s / carer’s been notify of this incident?

Yes No

If YES please provide details of what was said/action agreed

Are you reporting your own concerns or responding to concerns raised by someone else:

Responding to my own concerns Responding to concerns raised by someone else

If responding to concerns raised by someone else:

Their Name

Their Telephone Number

Position within the sport or relationship to the child

Their Email Address

Date of incident

Time of incident

Details of the incident or concerns

Child’s account of the incident

Thank you for completing the form – we will be in contact

At United Twirl England, the safety, welfare and wellbeing of everyone involved in our sport is of the utmost importance. We are committed to providing a safe, inclusive and respectful environment where children, young people and adults can participate with confidence. We take all safeguarding concerns seriously and encourage anyone who has a concern, however small, to report it using the Safeguarding Incident Form below. All concerns will be treated sensitively, respectfully and confidentially, and will be dealt with in accordance with our safeguarding policies and procedures. If you have a concern, please do not hesitate to report it — speaking up can help protect the wellbeing of everyone within our United Twirl England community.