TEACH A MAN TO FISH CHILD PROTECTION & SAFEGUARDING INCIDENT REPORT FORM
Have you witnessed an incident that is against Teach A Man To Fish's Code of Conduct, or that has put a participant’s safety in danger?

Please complete this form to the best of your knowledge within a maximum of 24 hours of the incident.  
Please note for confidentiality reasons, the report should be written solely by you.
This information will be held in a secure location and will be treated in the strictest confidence.
You will be informed how Teach A Man To Fish is responding to this incident, if you wish.
Please ensure to give your email address and/or phone number so that we can contact you.
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Email *
Country *
Your name *
Please share your name. If you want to stay anonymous, please write "Anonymous" instead of your name
Your email address / phone number *
If you prefer to remain anonymous, please write the word "Anonymous"
Your job title / role *
Name of alleged perpetrator *
"Perpetrator" refers to the person that you witnessed putting a participant in danger
Name of participant(s)/victim(s) against whom the incident occurred *
Gender of participant(s) *
Required
Age of participant *
Date of alleged incident *
MM
/
DD
/
YYYY
Time of alleged incident *
Time
:
Location of alleged incident *
Please provide details on the location (e.g. in the classroom of xxx school in Kampala, Uganda)
Please describe the nature of the allegation *
Please add as much detail as possible.
Was the incident observed, suspected or divulged to you by another party? *
What was/is the participant’s physical and emotional state? *
Has the participant said anything to you, and how did you respond? *
Were there any other people involved? *
If so, how many other people were involved, and who are they?
What response have you taken, if any, to the alleged incident? *
Which other parties, if any, are also aware of the alleged incident? *
Who else did you report the incident to?
Please provide details of other staff members and community members who can verify the incident *
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