Professional Safeguarding Referral

Safeguarding means protecting an adult's right to live in safety, free from abuse and neglect.

Please use this form if you are concerned that an adult:

• Has care and support needs
• Is experiencing, or may be at risk of abuse or neglect
• May be unable to protect themselves because of those needs.

If somebody is at immediate risk of harm, contact the Police on 999 before completing this form.

Please provide as much information as possible about:

• The adult at risk.
• Your concerns.
• Any person alleged to have caused harm.
• Any actions already taken to safeguard the adult.

If further information is required, Adult Care may contact you to discuss the referral. If you may be unavailable following submission, please provide details of an alternative contact within your organisation who can discuss the referral if required.

Before starting this form, it may be helpful to have:

• Details about the adult at risk.
• Your own contact details
• Information about the concern being reported (please see in form guidance)
• Information about any person alleged to have caused harm
• Details of any actions already taken

Consent should be sought wherever possible, but a safeguarding concern can be raised without consent where there is reason to suspect an adult may be at risk of abuse or neglect.

• This form should take approximately 10–15 minutes to complete.
• The session will time out after 20 minutes of inactivity