BRITISH AIKIDO BOARD INCIDENT REPORT FORM

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GUIDANCE ON BRITISH AIKIDO BOARD INCIDENT REPORT FORM

APPENDIX 1

BRITISH AIKIDO BOARD INCIDENT REPORT FORM

Details of report writer: Date of report: ……………………………

Association

Club

Your Name

File Name:

Time and Date of incident

Brief Details of incident

Child’s Name

Date of Birth

Sex:

Child’s Address

Parent/Carer’s Address

Disability (if applicable):

Ethnic Group (Circle appropriate category)

White

¢ British

¢ Irish

¢ Other, please specify

Mixed

¢ White Black Caribbean

¢ White Black African

¢ White Asian

¢ Other mixed background, please specify

Asian or

Asian British

¢ Indian

¢ Pakistani

¢ Bangladeshi

¢ Other Asian background, please specify

Black or Black British

¢ Caribbean

¢ African

¢ Other Black background, please specify

Chinese or other

Oriental group

¢ Chinese

¢ Other, please specify

Other group not included above

¢ Please specify

or:

None of the above – Prefer not to Specify ¢

Child – state what the child said –

Referrer Observed – state only what you saw OR

If reporting on what someone else saw note that with the persons name and ask they write a brief report of what they observed.

Referrer: Please note comments and immediate action taken by you/others


Identity of Person Implicated in the referral Name
Role in Aikido: Club: Relationship between above person and child:
Ethnic origin, please state as per chart above:
Marital Status		Age
Address
Contact details: Phone:

External Agencies Contacted (Dates & Times)
Police	Contacted by:		Date & Time:
	Contact Name and Number:

Children’s Social Care services	Contacted by:		Date & Time:
	Contact Name and Number:

BAB (e.g.CPO)	Contacted by:		Date & Time:
	Contact Name and Number:

Local Authority	Contacted by:		Date & Time:
	Contact Name and Number:

Other (e.g. NSPCC)	Contacted by:		Date & Time:
	Contact Name and Number:

This appendix is part of the BAB Safeguarding Policy which is held as a PDF document in the download area (shown below) and should be considered as the only reference document. Although these pages will be kept up to date as much as possible they may not be as current or may be abridged in comparison to the Safeguarding Policy. After reading any information here please reconfirm from the latest version of the Safeguarding Policy.