Safeguarding Reporting Form

Please complete this form to report any concerns you may have about the behaviour of an adult towards a child, young person or adult at risk. You can also use this form to report any poor practice you have witnessed at clubs or footballing events. If there is a child, young person or adult at risk in immediate risk of harm or danger, please ring the police on 999 or the NSPCC on 0808 800 5000 and contact our Designated Safeguarding Officer on 07469 422520.

Details of the individual/club/event you are reporting

Name of the individual or club that you are reporting

This can be an individual or club whose behaviour towards U18s or adults at risk causes concern.

Club/Team/Event

Please provide details of the club or specific team and age group or the name of the event you wish to report

Role in Football

If applicable

Select

Your Details

You do not have to enter your details if you do not feel comfortable doing so. However if you do complete this section, please be assured that Herefordshire FA will only use your information to contact you to clarify the details of your report and will not disclose any of the details you have provided without your express permission.

Full Name

Email Address

Contact Telephone Number

Your Role in Football

Poor Practice Concern Details

Please provide as many details as you can about the poor practice concern. REMEMBER if there is a child or adult at risk in immediate risk of harm or danger, please ring the police on 999 or the NSPCC on 0808 800 5000 and contact our Designated Safeguarding Officer on 07555754314.

Your Report

Please provide as many details as you can. Please consider the following when writing your report: *Where you witnessed the poor practice * If the information you are disclosing is on behalf of someone else * If you personally witnessed the poor practice * Were there any other witnesses * What is your relationship to any victims of poor practice * The relationship of the person you are reporting to the victim(s) * Be clear what is fact and what is opinion * If you have reported your concern to the police, LADO, Children's or Adult Services, The FA or any other body

Other useful information

Please upload any other relevant information here such as photographs, supporting documents or screen captures.

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Thank you for contacting us. Remember if you see it or hear it - REPORT IT!

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