SAFEGUARDING CONCERN LOG · Free template · The Safeguard Hub (safeguard-hub.org) · KCSIE 2025 aligned · NOT for pupil educational file — store in secure DSL records

Safeguarding Concern Log

Complete one form per concern. Record contemporaneously — as soon as possible after the incident/disclosure. Use the child's own words where relevant. Do not investigate or ask leading questions.

⚠️ If you believe a child is in immediate danger, call 999 first. Then inform the DSL. Do not wait to complete this form.

PART A — Child Details

Child's full name
Date of birth
Year group / class
Any SEND / communication needs
Looked after / CIN / CP plan?
Siblings at school (names, year groups)

PART B — Nature of Concern

Date and time of concern / disclosure
Where did this occur?
Type of concern (tick all that apply)	☐ Physical abuse ☐ Emotional abuse ☐ Sexual abuse ☐ Neglect ☐ Peer-on-peer abuse ☐ Online safety ☐ Domestic abuse ☐ CSE / CCE ☐ Radicalisation / Prevent ☐ Missing / unexplained absence ☐ FGM / HBA ☐ Self-harm ☐ Other: _______________
Description of concern (use child's exact words where a disclosure was made — do not paraphrase)
Any physical indicators observed? (describe location and appearance — do not photograph)
Behaviour / emotional indicators observed
Any witnesses?

PART C — Person Raising the Concern

Name and job title
Date and time of this record
Did you respond to a disclosure?	☐ Yes ☐ No — concern was observed / reported by a third party
If yes — what did you say to the child?

PART D — DSL Actions (completed by DSL)

DSL informed (name, date, time)
DSL decision	☐ Monitor and review (reason: ______________________________) ☐ Early Help referral ☐ Consult MASH (no formal referral at this stage) ☐ s.17 referral — Child in Need ☐ s.47 referral — Child Protection ☐ LADO referral (concern about staff member) ☐ 999 called
Referral made to
Date and time of referral
Name of person spoken to at MASH / agency
Written confirmation sent within 1 working day?	☐ Yes — date sent: _________ ☐ N/A
Parents / carers informed?	☐ Yes — date: _________ ☐ No — reason: _______________________________
Next review / follow-up date
Further actions / notes

PART E — Signatures

Person raising concern	Signature: Date: ___________
DSL	Signature: Date: ___________

Storage: File in the child's secure safeguarding file (not educational file). Retain until the child is 25, or 75 years in cases involving abuse (IRMS guidance). Do not leave on a shared drive.
Statutory references: KCSIE 2025, paras 70–78 (Record-keeping) · Working Together 2026 · Children Act 1989 s.17 and s.47
Free template from The Safeguard Hub (safeguard-hub.org). Review before adoption. Not legal advice.