Agency reporting form for allegations against staff and volunteers working with children and young people in the London Borough of Sutton

Agency reporting form for allegations against staff and volunteers working with children and young people in the London Borough of Sutton
This form is to be used in cases where it is alleged that an adult who works with children (either paid / unpaid/ self-employed) has:
- behaved in a way that has harmed or may have harmed a child
- possibly committed a criminal offence against or related to a child
- behaved towards a child/ren in a way that indicates s/he is unsuitable to work with children
If the allegation meets any of the above criteria, the employer should report it to the LADO within 1 working day. Complete this form fully.

The Lead LADO is Sima Hirani. If you wish to have a consultation before making a referral contact the Duty LADO on 0208 770 4776 or email LADO@sutton.gov.uk.

If immediate action is required to protect a child outside office hours contact the Children’s Emergency Duty Team on 0208 770 5000.

Once completed and submitted, you will have a response within 1 day in terms of next actions.
Details of person making the referral
Date of referral*
Name of referrer*

First NameLast Name
Job title*
Name of organisation*
Address of organisation*

Street Address

Street Address Line 2

CityCounty

Post Code
Phone number*
Email*
example@example.com

Details of adult against whom the allegation has been made
Full name of staff and or volunteer*

First NameLast Name
Job title *
Place of work (include agency contact details if relevant)*
Gender Identity*

Woman.Man.Transgender.Non-binary/non-conforming.Unknown at the time of referral
Date of birth

DayMonthYear
Ethnicity of staff or volunteer *
Full Address of Staff/Volunteer*

Street Address

Street Address Line 2

CityCounty

Postcode
Does the person have children of their own and or care for children in a personal capacity, either full time or occasionally at home or at another address?*

YesNoUnknown
If yes, provide name(s), date of birth of children or approximate age and relationship to children
Does the person have any other contact (through other work and or volunteering) with vulnerable individuals (children or adults)? If yes, provide details.

Details of the allegation or concern
Date and time of incident
Location of incident
Description of allegation or concern: provide as much information as possible including details of any injuries or harm and any witnesses to the incident and any action(s) taken.*
Upload any written incident reports or body maps, if available.

Cancelof
What action(s) has been taken regarding the allegation so far? Has any immediate safeguarding action been taken? Have referrals to the Police and Children’s Social Care been made (if appropriate)?
Do you believe the individual poses a risk of harm to children and young people in the organisation? If yes what action has been taken to mitigate risk.
Should be Empty:

Details of person making the referral