Safeguarding Report

Safeguarding Reporting

This form is to be completed by any staff member, tutor, coach or volunteer who has a concern about the safety or wellbeing of a student.

⚠️ If the student is in immediate danger: Please ensure that the Designated Safeguarding Officer (DSO) is informed immediately before completing this form, via WhatsApp text.

1Reporter Details

2Student/Person Details

3Incident Details

Name of person completing this form(Required)

First Last

Your Email(Required)

Your role or position(Required)

Teacher / Summerhill Staff

Parent

Tutor

Student

Other

Name of Student/Person Concerned(Required)

First Last

Grade of Student(Required)

Age of Student(Required)

Gender of Student(Required)

Name of Student's Teacher(Required)

First Last

Date of Incident(Required)

Time of Incident

Hours

Minutes

AM/PM

Type of Safeguarding Concern(Required)

Child Protection (physical, emotional, sexual abuse, neglect, Peer-on-peer abuse, bullying, and cyberbullying)

Online Safety (cyberbullying, grooming, exposure to inappropriate content, digital misconduct)

Mental Health and Wellbeing (emotional distress, withdrawal, self-harm risk, anxiety, depression, bullying impact)

Confidentiality and Data Protection (unauthorised sharing of student data, breach of confidentiality, misuse of images or recordings)

Other

Description of Concern(Required)

Upload a handwritten/typed report if the incident requires more writing

Max. file size: 128 MB.

Were there any witnesses(Required)

Yes

Please disclose witnesses(Required)

Have you taken any action following the incident or disclosure?(Required)

Yes

What action(s) did you take?(Required)

Is the student safe now?(Required)

Yes

Unsure

Please elaborate on student's safety(Required)

I confirm that the above information is true and complete to the best of my knowledge and that this report will be treated as confidential.(Required)

Yes

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