Fairlawn Church Safety Concern Report Form

This form should be used to speak up to the Safeguarding Team regarding any violation of the Abuse, Misconduct, and Protection Policy, any boundary violations or other unsafe behavior, or any other safety concern. Proof or direct knowledge of a behavior or incident is not necessary to submit this form. You are not making a personal judgment about a person or their motivation by submitting this form. Provide whatever information you do have. The Safeguarding Team will assess any information and take any reasonable steps to reinforce safe behaviors.

First Name *

Last Name *

Mobile Number *

Today's Date

What happened or what is the concern? (be as specific as you can in terms of who, when, what, and where.)

If this came to your attention, from whom or how did it come to your attention?

Is there anyone else not listed above who may have helpful information?

Is there anything else you want the Safeguarding Team to know (other information or other steps you have taken, etc.)?