Safeguarding Concern Form

Use this form to report concerns about abuse, neglect or the welfare of an adult at risk. If there is an immediate risk to life, call 999 first.

Full Name

Organisation

Job Title

Telephone Number *

Email Address *

Full Name *

Address

Date of Birth (if known)

Type of concern

Physical Abuse Emotional Abuse Sexual Abuse Financial Abuse Neglect Self-Neglect Domestic Abuse Modern Slavery Other

Concern Details *

Is there an immediate risk? *

Yes No

Have emergency services been contacted?

Yes No Not applicable

Supporting Evidence Upload

Note: file metadata is recorded; please email any attachment to the address above.

I understand this information may be shared with relevant safeguarding authorities.

Ewaldine

Care Group

Compassionate Care, Every Day.

01752 977 735
info@ewaldinehomecare.co.uk
Office 5, Unit 26, Devonshire Meadows,
Broadley Park Road, Plymouth,
Devon, PL6 7EZ
24/7 Care Support Available