Safer Churches - Concerns Anecdotal Record • Breakthrough Church

Safer Churches - Concerns Anecdotal Record

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Mobile Number

Today's Date *

REPORT

Name of the person about whom you have a concern

Contact details of this person (if known)

Age of person about whom you have a concern (if unknown - approximate)

Your (the reporter's) relationship to the person about whom you are concerned

Please describe your concerns, what was observed or what was said.

It is important to provide as much information as possible, basing your information on facts and observations, without making assumptions or jumping to conclusions or making “value” judgments.

If a disclosure has been made to you (the reporter), a verbatim (word for word) record should be written of the disclosure to the best of the your ability, as soon after the disclosure as is practical.

Describe your concerns

Please provide any further information you think may be helpful

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FOR OFFICE USE ONLY

Report received and filed by (Name):

Report received and filed (date):

Notes