Safeguarding Children & Vulnerable People Handbook

Confidential

Report information: Date and time of incident

Accurately record the size and location of any injuries.

Nature of the allegation (what happened, what you observed, behaviour, other comments):

Were there any witnesses? If so, what are their names, relationship to the alleged victim and contact numbers?

Accurately record what the alleged victim or person reporting said when describing what happened.

Authentication

Name of person completing form:

Signature of person completing form:

Date form forwarded to CEO and CVPO Officer:

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Date form completed:

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Member Handbook July 2016 St John Ambulance SA Inc