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Concern Recording Form

September 1, 2017    ·    Drew    ·    Match Reports

BURNTISLAND SHIPYARD AFC

 

CONCERN RECORDING FORM

 

This form must be completed as soon as possible after receiving information that causes a concern.  Contact the Young Player Protection Officer on mobile number to report the concern then email the completed form to email address as soon as possible after completion; do not delay by attempting to obtain information to complete all sections.  Please do not keep any electronic, printed or written versions of this form.  It is important to maintain confidentiality to delete or shred as soon as the information has been passed on.

 

Complete Part A where the concern relates to the wellbeing of a young player and/or Part B where the concern relates to the conduct of an adult.  Finally, complete Part C to provide your contact information.

 

PART A – WHERE THERE ARE CONCERNS ABOUT THE WELLBEING OF A YOUNG PLAYER

 

(SAFE, HEALTHY, ACTIVE, NURTURED, ACHIEVING, RESPECTED, RESPONSIBLE, INCLUDED)

 

  1. Young Player’s Details

 

Name: Date of Birth:

 
Address:

 

Post Code:

 Tel No:
Young Player’s Named Person:

 

 Named Person Tel No:

 

 
Preferred Language:

 

 Is an interpreter required?

YES / NO
Any Additional Needs?

 

 

  1. Details of situation giving rise to Concerns

(including date, time, location, nature of concern, who, what, where, when, why)

 

 

 

 

 

  1. Details of any witnesses/other people involved

(including names, addresses and telephone contacts)

 

 

 

 

 

  1. Details of any injuries

(including all injuries sustained, location of injury and action taken)

 

 

 

 

 

  1. Young Player’s views on situation (if expressed). Where possible, please use the child’s own words.

 

 

 

 

 

 

 

PART B – WHERE THERE ARE CONCERNS ABOUT THE CONDUCT OF AN ADULT

 

  1. Details of adult where there are concerns about their conduct

 

Name:

 

 Tel No:
Address:

 

Post Code:

 Relationship to Child:

 

  1. Details of concerns

(including date, time, location, nature of concern, who, what, where, when, why, continue on a separate sheet if necessary)

 

 

 

 

 

 

  1. Details of any action taken

 

 

 

 

 

 

 

  1. Details of agencies contacted

(including date, time, name of person contacted and advice received)

 

 

 

 

 

 

  1. Have the young player’s parents/carers been informed?          YES / NO        (delete as appropriate)

If yes, record details / If no, please state why not

 

 

 

 

 

 

PART C – YOUR CONTACT INFORMATION

 

  1. Details of Person Recording Concerns

 

Name:

 

 Tel No:
Address:

 

Post Code:

 Position/Role:

 

 

 

Signed:                                                                                               Date:              

 

 

Burntisland Shipyard AFC August 2017