Online Student Safeguarding Disclosure Form

Online Student Safeguarding Disclosure Form
1. Does your Safeguarding Concern involve an immediate risk to life or serious harm?*

YesNo
Yes, immediate risk to life or serious harm

Please do not report concerns through this form where there is an immediate risk to someone’s life or serious harm. Inform any member of staff and they will take action accordingly.
2. I'm a:*

StudentStaff MemberVisitor
I am concerned about the welfare of:*

MySelfSomeone Else
3. My safeguarding concern relates to the following campus:*

CroydonDigbethSheffieldLeicesterLutonHead Office
4. Details*

I would like to include my name and personal detailsI would like to make a disclosure anonymously
Making a disclosure anonymously means that we don’t know your name or any personal details about you. It may limit our ability to support the people involved, or conduct any investigations.

Details of my safeguarding concern*
Please include specific details as appropriate such as what the concern is; names of people involved; dates and times of incident(s).
Thank you for making this safeguarding disclosure. One of our Designated Safeguarding Officers will get back to you within 48 hours.
Should be Empty:

	info
My Name
My Student ID number (if relevant)
My email address
My phone number

Yes, immediate risk to life or serious harm