If a volunteer, supporter, or beneficiary is concerned about a patient beneficiary, volunteer, supporter or anyone else connected with the charity then you must complete the form below. This form must be completed at the first possible opportunity and no later than one working day after being informed about a concern. If you are unable to complete the form then you must phone Look Good Feel Better as soon as possible on 01372 747 500 and ask to speak to the SSPOC.

The information recorded on the form must be factual and not based on opinions, recording what the person has said or what has been witnessed, with the specific nature of the concern.

If it is an emergency and the person is in immediate danger, phone the police on 999.

What exactly did you see/ hear/ witness?

IMPORTANT: Please write clearly and only write facts of what you heard or saw. Use exact words, even if the language you heard was unpleasant.

If you do need to clarify anything, please state clearly that is it your opinion or assumption

Where (exact location/venue)

When the incident is alleged to have taken place (date and time)

A description of the person’s behaviour, their physical or emotional state

PERSON AT RISK REPORTING THE ABUSE OF NEGLECT

Only complete this section if the person at risk reported the incident to you. Record exactly what the person has said happened using their exact words, even if this is unpleasant language, and anything you said to the person. Remember you should not investigate, but simply record here.

Safeguarding at Risk - Reporting Form