Safeguarding

Every child and young person who plays football/soccer should be able to participate in an enjoyable and safe environment and be protected from any and all forms of abuse. It is critical that all of the sections below are reviewed and policies adhered to.

Incident Form

Lead Child Protection/Safeguarding Officer

Name: John Mills
Mobile: +44(0)7979 752006
E-Mail: [email protected]

Safeguarding Policy

Responsibilities of Licensees

Responsibilities of Staff & Volunteers

Safe Recruitment and Selection

Codes of Conduct & Other Policy Docs

Taking Teams Away

Child Abuse, Lower Level Concerns and Poor Practice

Responding to Concerns, Allegations and Disclosures

Case Management and Record Keeping

Safeguarding Recordings & Sessions

Coerver Coaching Incident Reporting Form

Step 1 of 4

Your Details

Your Name(Required)

First Last

Name of your organisation / Coerver Coaching territory(Required)

Your Role(Required)

Your Phone(Required)

Your Email Address(Required)

Enter Email Confirm Email

Your Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child & Parent / Carer Details

Child Name(Required)

First Last

Child Name(Required)

First Last

Child D.O.B(Required)

Child’s Ethnic Origin:(Required)

Does child have a disability?

Child’s Birth Gender:(Required)

Parent’s / Carer’s Names(Required)

First Last

Parent's / Carer's Phone(Required)

Parent's / Carer's Email(Required)

Parent's / Carer's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Parent’s / Carer’s Name

First Last

Additional Parent's / Carer's Phone

Additional Parent's / Carer's Email

Have parents / carers been notified of this incident?(Required)

If YES please provide details of what was said / any actions agreed:(Required)

Incident Details

Are you reporting your own concerns or responding to concerns raised by someone else?(Required)

If responding to concerns raised by someone else:(Required)

Concern Raised By Name(Required)

First Last

Concern Raised By Phone(Required)

Concern Raised by Email(Required)

Date of Incident(Required)

Details of the incident or concerns:(Required)

Incident Further Details

Please provide details of any person involved in this incident or alleged to have caused the incident / injury.

Name(Required)

First Last

Position within the organisation or relationship to the child:(Required)

Date of birth (if a child):

Involved Person Phone (or Parent if a child)(Required)

Involved Person Email (or Parent if child)

Please provide any witness accounts of the incident:

Please provide details of any action taken to date:

Incident Further Details Cont...

Has the incident been reported to any external agencies?(Required)

If YES please provide further details:(Required)

Name of organisation / agency:(Required)

Contact Name(Required)

First Last

Contact Phone(Required)

Contact Email(Required)

Agreed action or advice given:(Required)

Signed

You should also send a copy of this form to the Coerver Coaching Lead or Deputy Lead Safeguarding Officer by email once received after submitting.

Signature(Required)

Signed by Name(Required)

First Last

Signed By Date(Required)

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