Safeguarding - Cause for Concern Form (Adults)

Designated Safeguarding Lead – Dr Joanna Lawrence

Date of report *

Date of incident *

Your full name *

Your phone number *

Person's first name *

Person's surname *

Person's approximate age *

Person's address *

Which service(s) does the person attend at the Tabernacle?

Are they involved in children's work? *

What has led to your concern about this person? *

What action have you taken in response to this concern? *

What children's Layout

This form will be sent to the Designated Safeguarding Lead who will consider the concern raised and act on the information as appropriate. Once submitted, if you wish to make any changes to the form or your account, you can either submit a new form or email Adult@TabSafe.org

Metropolitan Tabernacle Elephant & Castle, London

Safeguarding – Cause for Concern Form (Adults)

Designated Safeguarding Lead – Dr Joanna Lawrence