HACKNEY INCIDENT /DISCLOSURE FORM
All allegations, complaints or suspicions of abuse should be recorded as close as possible to the time of the incident. Details of incidents should be recorded in as much detail, and as accurately as possible. Any disclosures of abuse
being made by children and young people should be a reflection of what was actually said. Do not try and interpret any of the information. Just record what was said or witnessed.

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Email *
Your Name
Contact Number
Date and time of incident or disclosure
MM
/
DD
/
YYYY
Name, age, ethnicity or religion, any disabilities of person(s) involved
Names of parents or carers, address and telephone numbers of person(s) involved
Names, ages, telephone numbers and addresses of any witnesses
Name, role and contact details of person completing this form
Details of what happened or disclosure of allegations (do not interpretinformation – use the same language that was used by the young personor child). Are you reporting your own concerns or those reported bysomebody else?
What action was taken (if not action was taken explain why)
Who did you report the incident to (names and contact details) - Woodcraft? Other Agencies? Parents / Carers?
Are any other young people potentially at risk?
Any other relevant information
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