Information
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LEARNER ID. NO.:
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Date of report:
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Report made by:
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SAFEGUARDING REFERRAL FORM TO REPORT CONCERNS TO DESIGNATED SENIOR PERSON (DSP)
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LEARNER NAME:
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Learner ID. No.:
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Date of birth:
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Course being studied:
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Details of allegation: (Prompts - what happened, what was said, the manner/tone of what was said, the emotional state of the young person, what you observed, who was present, when and where it was said)
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Action taken: ( remember you must not ask leading questions or investigate the situation)
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Date sent to DSP:
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Signed:
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Actions taken by the DSP:
