Use this for anything that worries you about a child — something you saw, something they said, something a parent said, a mark, a change in them, or just a feeling you cannot shake off. You do not have to be sure. You do not have to be senior. It is not your job to decide whether it is serious. It is your job to pass it on.

⚠️ Have you told someone?

Filling this form in is not telling anyone.

If you are worried about a child, go and find the Designated Safeguarding Lead now and say it out loud. If they are not here, tell the Deputy DSL. If neither is here, tell the manager. Do it before you come back to this screen.

This form writes down what you did and when, so there is a record with a date on it. That matters later. It is not the thing that keeps a child safe today. You are.

The child

Child’s name

Date of birth or age optional

Site

Room or area

What happened

Write what you saw and heard, not what you think it means. Stick to the facts and keep your opinion out of it — if you want to add what you think, put it at the end and say that is what it is.

What date?

Roughly what time? nearest 15 minutes — or say you are not sure, at the bottom of the list

Where? optional

What did you see or hear?

Who else was there? optional

The child’s own words

If the child said anything, write it down exactly as they said it — their words, their grammar, their mistakes. Do not tidy it up and do not turn it into a sentence of your own. This is the most important box on the page.

Do not ask them questions to find out more. Listen, let them finish, and write it down. Asking leading questions can make what a child says unusable later.

Write their exact words

Any marks or injuries

Only if there are any. Tap the picture where you saw it, then describe it. Front and back. Do not photograph a child.

No marks recorded. Tap the picture if there are any.

Is this about a member of staff?

Something a member of staff did, or did not do — including if you are not sure. This changes who sees it.

Does this concern involve a member of staff?

What you did, and who you told

This is the part that gets forgotten and the part that gets asked about.

What did you do at the time? optional

Who have you told? required — their name

When did you tell them?

How?