4. Leadership & Management

Annex 2: Recording Form

Recording Form

Child’s name: Date and time of disclosure

D.O.B

Name and role of person raising concern/taking disclosure:

Details of concern (Who? What? Where? When? Any factual, observable behaviours when disclosing? use child’s exact words)

Actions taken Action taken/ decision made and reasons for it

Person taking action

Date and time

Outcome of action

Name of person completing record:

Role:

Staff involved: Date information shared (if different from above): Date information recorded for file e.g. CPOMS (if different from above):

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