Child Protection Incident Report Form

Details of person making the report:

Name .....................................................
Date .....................................................
Address .....................................................
Address .....................................................
Post Code .....................................................
Telephone - Home .....................................................
Telephone - Mobile .....................................................
E-mail .....................................................

Details of child affected:

Name .....................................................
Date .....................................................
Address .....................................................
Address .....................................................
Post Code .....................................................
Telephone - Home .....................................................
Telephone - Mobile .....................................................
E-mail .....................................................

Details of Child ’s Parent/Guardian:

Name .....................................................
Date .....................................................
Address .....................................................
Address .....................................................
Post Code .....................................................
Telephone - Home .....................................................
Telephone - Mobile .....................................................
E-mail .....................................................

Details of the Incident:

Summarise the incident or concerns: .....................................................
.....................................................
.....................................................
.....................................................
Describe any action taken already: .....................................................
.....................................................
.....................................................
.....................................................

What to do now

Send Form Send the form to the STC Child Protection Officer - Ian Hunter tel 07786 637361
Immediate Risk If you believe that someone may be at immediate risk, you should contact your local police ( tel 621 411 ) or social services department. Dial 999 if there is an emergency.
Do Not Discuss Apart from the police or social services, you should not discuss this referral with anyone before taking advice from your STC CP officer Ian Hunter or any LTA Child Protection officer � contact details below.
LTA Child Protection T: 0208 487 7008/7116
M (24 hour): 07971 141 024
F: 0208 487 7301
E: childprotection@lta.org.uk
Tennis Scotland Matt Hulbert - T: 0131 444 1984