Luminary 2024 Safeguarding Incident Form

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This form is to capture any information about your safeguarding concern - please give as much detail as you are able.

Name of individual(s) the concern relates to *

Status of individual the concern relates to

(tick all that apply)

Luminary Trainee

Luminary Graduate (still receiving progression support)

Luminary Alumni (no longer receiving 1-1 progression support)

Luminary Team Member

Member of the Public

Family member of Luminary woman

Unknown

Other:

Clear selection

Cohort Number (if relevant)

If there was a specific incident, where did it occur? *

Incident Date

YYYY

Describe the incident or concern? *

Were/are there any witnesses? *

If so - please include their contact details

Who have you discussed the incident with? *

Please include their contact details

What action has been taken? *

Any external reference numbers? Eg Crime Reference

Any additional information *

Name of person completing form

*You are able to submit this form anonymously if required, however this may make it difficult for us to follow up*

Your Job Title

Your Phone Number

Today's Date *

YYYY

Submit

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