Royal Life Saving Society UK - Online Safeguarding Report Form

Please complete the following sections with as much detail about the specific safeguarding concern or allegation as soon as possible. A member of RLSS UK Central Safeguarding Team will contact you as soon as possible after receiving the referral.

If any person is at immediate risk of harm or requires medical attention, then the emergency services should be contacted immediately by telephoning 999.

To keep children and adults at risk safe, information may need to be shared appropriately with other organisations*. However, confidentiality will be maintained where appropriate and to ensure that only those who need the information are made aware of it. If you have any queries or concerns about the information you are providing, please contact RLSS UK’s Central Safeguarding Team on 0300 3230 096 and follow the prompts.

First Name: Person reporting the safeguarding concern.

Surname: Person reporting the safeguarding concern.

Phone: Person reporting the safeguarding concern.

Email: Person reporting the safeguarding concern.

Role:

Persons Involved

Victim

Adult (18+) or Child?

Adult (18+)

Child

Has adult given consent for referral?

Yes

Name of Alleged Victim:

First Name

Surname

Date of Birth:

Phone: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Email: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Subject of Concern

Name of Subject of Concern:

First Name

Surname

Date of Birth:

Role:

Society Number of the subject if known:

Sex:

Male

Female

Address:

Post Code:

Telephone Number:

Email Address:

Incident Details

Date Occurred:

Time Occurred:

Name of Club:

Incident Type:

Category of Concern:

Inside or Outside of Sport:

Location of Incident:

Describe what happened: Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.

Attachments:

*Data Protection Notice
Information provided through this form will be used to record, assess and manage safeguarding concerns. RLSS UK processes this information under Article 6(1)(f) UK GDPR (Legitimate Interests) and, where special category data is involved, Article 9(2)(g) UK GDPR and Schedule 1, Part 2, Paragraph 18 of the Data Protection Act 2018 (Safeguarding of Children and Individuals at Risk). Information may be shared where necessary to protect individuals from harm. For more information, please see our view our privacy policy available here www.rlss.org.uk/privacy-policy.