British Ice Skating: Initial Issue/Concern Reporting Form

Please provide information on this form, if you have a concern or an issue relating to someone or something within your Ice rink or Ice Skating club. I understand that the information I provided may be used for the benefit of the National Ice Skating Association and if required will be shared with Statutory Agencies.

First Name: * Person reporting the safeguarding concern.

Surname: * Person reporting the safeguarding concern.

Phone: Person reporting the safeguarding concern.

Email: Person reporting the safeguarding concern.

Role:

Persons Involved

Victim

Person who concerns are for

Adult (18+) or Child?

Adult (18+)

Child

Is the victim aware of the report?

Yes

Name of Alleged Victim:

First Name

Surname

Date of Birth:

Phone: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Email: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Role:

Please Specify:

Subject of Concern

Person who is accused of alleged wrongdoing

Name of Subject of Concern:

First Name

Surname

Date of Birth:

Role:

Sex:

Address:

Post Code:

Telephone Number:

Email Address:

Actions already taken: Are you aware of any local authority /police involvement in this case? If yes, please provide details

Have any of the individual's family or carers been notified of this concern?

Yes

If yes please provide details of what was said/action agreed.

Has British Ice Skating been contacted about this case?

Yes

Details of Concern

Date Occurred:

Time Occurred:

Location of the incident and nationality of people involved:

Incident Type:

Category of Concern:

Inside or Outside of Sport:

Describe your concerns: Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.

Are you reporting your own concerns or responding to concerns raised by someone else?

If responding to concerns raised by someone else please their contact information. Name, Position within the sport or relationshop to the individual concerned, telephone number, email address

Witnesses or Supporting Accounts Please provide details of any one who has shared your concerns or witnessed any incident: Name, Position within the sport or relationship to the individual concerned, DOB, Address, Postcode, Telephone Number, Email Address

Conflicts of Interest: Do you have any relationship with anyone involved in this case which could cause a conflict of interest in any investigations? If yes, please describe your relationship

Signature:

Use of the Initial Issue/Concern Reporting Form What should be reported?
The welfare of the child is paramount. In order to assist BIS and your club in upholding this principle you are asked to complete the form for any issues/concerns or incidents. When completing the form please give full names and their rink / club roles. Concerns may be about the behaviour of any child or adult involved or spectating at your rink / club and could include:
General concerns about a child’s welfare
Concerns related to a safeguarding incident e.g. bullying or poor practice
Concerns, Suspicions or allegations of misconduct
Breaches of the BIS Safeguarding Policy
Allegations of abuse made by or against any child or adult at risk
To discuss a specific concern or issue please contact the BIS Safeguarding Team in the first instance by calling Tel: 07539 697819 or email: safeguarding@iceskating.org.uk
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