Step 1 of 7 – Section 1 – Details of person involved in the incident

14%

Name of person raising concern(Required)

First Last

Relationship to incident

e.g. child, parent, witness, instructor etc.

Name of person subject to concern/allegation(Required)

First Last

Age (if known)

Please enter a number from 0 to 99.

Date of birth (if known)

DD slash MM slash YYYY

Alleged victim(s) if different to person raising concern

First Last

Age (if known)

Please enter a number from 0 to 99.

Date of birth (if known)

MM slash DD slash YYYY

Name of person completing this report(Required)

First Last

Phone(Required)

Email(Required)

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Role in Organisation/Club

Organisation Club/Name

Date of incident (if known)

DD slash MM slash YYYY

Time of incident (if known)

Hours

Minutes

AM/PM

If unknown, state the period when the incident is believed to have occured

This could be an event or approximate date/time

Location of incident(Required)

Nature of concern/allegation (tick all that apply)

Safeguarding concern

Bullying (verbal/physical/online)

Breach of Code of Conduct

Behavioural concern

Discriminatory incident (racism, sexism, disability, religion, etc.)

Harassment/intimidation

Emotional/psychological abuse

Sexualised behaviour or concern

Poor practice/welfare concern

Other

If other, please specify

Description of incident/concern(Required)

Provide as much detail as possible – what happened, who was involved, what was said/done using direct quotes where possible. Include dates, times, and any supporting evidence such as screenshots, emails, photos, or witness statements.

Supporting evidence

Max. file size: 192 MB.

Names of any other persons/witnesses present at the time of the incident

Has the person who raised the allegation been spoken to?(Required)

Yes

If yes, by whom, when (date/time) and what was said?

If a child, has the parent/carer been spoken to?

Yes

If yes, by whom, when (date/time) and what was said?

If not spoken to, state why (e.g. risk of increasing harm, not appropriate at this stage)

Has the alleged victim been spoken to?(Required)

Yes

If yes, by whom, when (date/time) and what was said?

If a child, has the parent/carer been spoken to?

Yes

If yes, by whom, when (date/time) and what was said?

If not spoken to, state why (e.g. risk of increasing harm, not appropriate at this stage)

Has the subject of the allegation been spoken to or informed of this concern?(Required)

Yes

In most cases, this should be ‘no’

If yes, by whom, when and what was discussed?

Action taken at the time of the incident(Required)

Was the Safeguarding Lead informed?(Required)

Yes

Referral to external agency (if applicable)

Police

Social Care

Other Agency

Details

Please explain the details of your referral to an external agency, any other action taken, or if no action has been taken.

Are other children, young people, or adults at risk?(Required)

Yes

If yes, provide details and actions taken

Declaration(Required)

I confirm this report is an accurate record of the information known to me at the time it was completed. Where quotations are used, they are identified as direct quotations. Other wording represents my own summary or observations.

Consent(Required)

I understand that this report will be reviewed by the appropriate Welfare Officer and/or TSKUK Designated Safeguarding Person, and that it may be shared with relevant agencies where necessary in line with safeguarding procedures.

Name(Required)

First Last

Date this record was completed(Required)

DD slash MM slash YYYY

Basket

Login

Register

TSKUK Incident Report Form

TSKUK Incident Report Form