Safeguarding Reporting Form

This form is for recording any safeguarding concerns, disclosures, or incidents involving

Mentees, Peer Mentors or any member of the Been There team.

Immediate Risk Of Harm:

IMPORTANT:

If you believe someone is at immediate risk of harm, do the following BEFORE completing this form:

  • encourage the person to call emergency services themselves whilst you speak to them

  • if they cannot or will not, then encourage them to give you their location so you can phone emergency services (the Police 999)

  • if they refuse, contact the Designated Safeguarding Lead (DSL) on duty immediately so they can contact emergency services.

Please try and keep talking to the person.

Try not to leave them alone.

NO Immediate Risk Of Harm:

If your concern is not an emergency, or once you have handed over to the DSL, please complete the following form:

  • In full

  • Accurately

  • Using clear and factual language (not your opinion)

The information you provide will be treated confidentially and shared only with the relevant safeguarding leads and external agencies as necessary.

For further guidance, please refer to our Safeguarding Policy and Standard Operating

Practise (Safeguarding)

DD-MM-YYYY
Describe clearly what you have heard, seen or been told using the person’s own words where possible. Be as brief as you can and try to avoid opinions.
This is in line with our Community Guidelines and our responsibility to safeguard the welfare of people.
(This is not always required but is preferable).
(for example from your Mentor Lead or a clinical supervision session with the Clinical Lead)

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