Safeguarding Incident Log

Use this form to report any safeguarding concerns to the SoMi Designated Safeguarding Lead (DSL). Complete it as soon as possible after the incident. If a child is at immediate risk, follow the school’s emergency safeguarding procedure first.

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Practitioner Details - Step 1 of 5

Your Name *

First

Last

Your Email *

Contact Phone Number *

School Name & Post Code *

Next

Name of Child *

First

Last

Year Group (if known)

GenderMaleFemaleOther / Unknown

Date / Time of Incident / Disclosure

Date

Time

Next

Nature of Concern (Tick all that apply)

• Disclosure made by child
• Observed injury or behaviour
• Third-party disclosure
• Concerning interaction with adult
• Neglect or unmet needs
• Online safety issue

Other (please specify)

Next

Describe exactly what happened or what was disclosed. Use the child’s own words where possible. Avoid assumptions or opinions.

Write clearly & factually

Next

Was the concern reported to the school’s Designated Safeguarding Lead

• Yes
• No

Name of school DSL (if known)

is of By

Time and date of report to school DSL

Any other actions taken? (e.g. phoned parent, removed from situation, logged on school system)

By submitting this form, you confirm the information is accurate to the best of your knowledge and that the report has been submitted in line with SoMi’s safeguarding policy. *

• I agree

Submit