Safeguarding Adults Concern

For Professionals/Providers only

1Safeguarding Adults - Tell us your concern

Safeguarding Adults - Tell us your concern

All information contained within this document is strictly confidential. It should not be used for any purpose other than the protection or care of the adult(s) concerned.
Please complete this form with as much information as possible.
In order to progress with this form you must either log in or complete a simple registration for a new account. You can then continue to complete this form. This will enable you to track the form at a later date.
What existing professional/care/support services is the person receiving (if any)?
Are they known to Pennine Care?
Details of the safeguarding concern
If appropriate, has a body map been completed? * This field is required
Type of concern * This field is required
Please select sub-categories as required
What does the person at risk want to happen now?
Has a conversation with the adult/representative taken place?
Outcomes are the wishes of the adult at risk or their representative which have been expressed for example an outcome may be what support they want to receive, it may be wanting to feel safe at home, maintaining independence, having no contact with certain people, change to care received, change of care provider, referral for therapy support etc.
Is the person aware of the referral? * This field is required
Has the person at risk given consent for these concerns to be raised? * This field is required
Did the person have mental capacity to give consent? * This field is required
Are there others at risk? * This field is required
Actions taken in relation to the safeguarding concerns?
Have the police been informed? * This field is required
Has medical intervention been sought? * This field is required
Where appropriate have family been made aware'? * This field is required
Information relevant to the investigation to be attached such as body map, statements, care records, incident forms etc.
Any other relevant information
Details of the person completing this form
In order to progress with this form you must either log in or complete a simple registration for a new account. You can then continue to complete this form. This will enable you to track the form at a later date.
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