Report a safeguarding concern

Please use this form if you have concerns that someone is being harmed, abused or neglected.

This form will go to the Lee Abbey London Designated Safeguarding Person who will review it and prioritise according to risk and urgency.

The person you are concerned about

Do you know the person's name?(Required)

Yes

No

Name(Required)

First name Surname

Is this person a resident or Community member at Lee Abbey London?

Yes

No

Don’t know

Please tell us their room number and when they were resident if you know

Contact details(Required)

As far as you know them

Is the person aged 18 or over?(Required)

They are 18 or over

They are under 18

Age or date of birth(Required)

The person's parent or carer (as they are under 18)

Please enter these details if you know them.

Parent or carer's name

First name Surname

Parent or carer's phone number

Country Phone Number

Parent or carer's email address

Second parent or carer's name (optional)

First name Surname

Second parent or carer's phone number

Country Phone Number

Second parent or carer's email address

Details of what has happened or is happening

What was said to have happened, or what was seen?(Required)

When and where did it occur?(Required)

Who else, if anyone, was involved, and how were they involved?(Required)

What was said by those involved?(Required)

Were there any obvious signs e.g., bruising, bleeding changed behaviour?(Required)

Please note if there are physical marks on the body that you have been shown, and where these are.

Who has been told about it, and when?(Required)

What do you intend to do about it (shared with the person concerned)?(Required)

Do the parents or carers know?(Required)

Form completed by

Name(Required)

First name Surname

Mobile phone number

To be used only for follow-up relating to this incident

Country Phone Number

Email address

To be used only for follow-up relating to this incident

When this form is submitted it will be timestamped and considered electronically signed by the person named in the box on this page. It will be stored securely on the web server and processed according to our privacy policy.