Safeguarding Concern Form - St Georges Deal

Step 1 of 4

This is a safeguarding concern for:

St George’s Church, Deal

Parish Safeguarding Officer:

Sue Fotheringham: 07352 336311 | safeguarding@stgdeal.org

Assistant Safeguarding Officer:

Rev Jean Kerr: 07352 336310
| safeguarding@stgdeal.org
Safeguarding Lead:

Rev Sheffield: 07710423432 | vicar@stgdeal.org
This form may be seen by the above as well as the Diocesan Safeguarding Officers. You may also wish to pass your concern directly to the Canterbury Diocesan Safeguarding Officers

Paul Brightwell: 07398 009951 | pbrightwell@diocant.org

Fiona Coombs: 07548 232395 | fcoombs@diocant.org

IF YOU THINK SOMEONE IS AT IMMEDIATE RISK OF HARM PLEASE CONTACT THE POLICE BY DIALLING 999

Person Being Referred

Name*

Person is

Alleged Victim

Alleged Abuser

Date of Birth (if known)

Approximate Age (if DOB not known)
Please enter a number from 8 to 80.
It is important that we have this information. If you are unsure of the age take a good guess. (A helpful hint – if you were asked are they 8 or 80 what would your response be?)

Address (if known)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Email Address (if known)

Mobile (if known)

Person Being Referred (if more than one)
Additional referral?
Name*
Person is

Alleged Victim

Alleged Abuser
Date of Birth (if known)
Approximate Age (if DOB not known)
Please enter a number from 8 to 80.
It is important that we have this information. If you are unsure of the age take a good guess. (A helpful hint – if you were asked are they 8 or 80 what would your response be?)
Address (if known)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code

Email Address (if known)

Mobile (if known)

Referrer Information
Your name
Your Role/Position
Email Address (if known)

Mobile (if known)

Situation Information
The concern involves
Children
Adults
Allegation (church officer)
The concern involves
Physical abuse
Neglect abuse
Psych/emotional abuse
Sexual abuse
Sexual abuse non-current
Child Sexual exlpoitation
Domestic abuse
Financial abuse
Discriminatory abuse
Organisational abuse
Spiritual abuse
Online abuse
Modern slavery
None of the above
Groups attended by the person you are referring
Date of Disclosure/Concern
DD slash MM slash YYYY

Initial information as reported. Please give as much information as you can. In the case of a disclosure please use the exact words that were said to you.
Consent*
I confirm that the information I have provided in this form is true, accurate and complete to the best of my knowledge. I understand that this information will be handled in line with the church’s safeguarding policy and data protection requirements.