Adult safeguarding referral form

Make a safeguarding referral if you suspect a vulnerable adult is at risk of harm or abuse by a third party.

If you are concerned about a vulnerable adult at risk of harm or abuse by a third party you should refer them for safeguarding.

The easiest way to do this is by completing our online form.

Completing this form will take approximately 15 minutes.

Please use this form for less urgent referrals only. If you feel they are in immediate danger please call 0808 800 4005 rather than completing this form, or dial 999 in an emergency.

Professional referrers

If you would like to discuss whether the situation you are concerned about should be the subject of a safeguarding referral, please contact the Multi Agency Safeguarding Hub (MASH) Consultation Line on 0345 6061499.

Make a safeguarding referral

Before reporting

To refer an adult for safeguarding using our online report form you will need the following information to hand:

  • Information about the person being referred, including:
    • Name
    • Address
    • Date of birth
    • Contact details
    • Is the person at risk aware of this report being submitted?
    • Has the person consented to the report?
    • Will contacting the person directly place them at risk?
    • Does the person require support with communication?
  • Your details, including:
    • Name
    • Relationship to victim
    • Contact details
  • Details of alleged abuser/suspect:
    • Name
    • Address
    • Relationship to victim
    • Organisation (if appropriate)
    • Role within Organisation (if appropriate)
    • Is the alleged abuser the main carer?
    • Is the alleged abuser also a vulnerable adult?
    • Does the alleged abuser have capacity to understand implications of their actions?
  • Information about your concerns:
    • Has this been reported to the police? Crime number? (if available)
    • Does anyone else know a referral is being made
    • Does the alleged abuser/suspect know of the referral?
    • Place of abuse
    • Date/time of incident
    • Reason for concern

 All information that we receive is treated with sensitivity and confidentiality.

After reporting

After you submit the form you will receive confirmation via email that will give you a reference number, if you do not receive this confirmation then please contact us on 0808 800 4005 as it's likely your form hasn't been sent successfully.

Once we have reviewed your referral we will contact you via the details you have submitted.

Other ways to report

Reporting online helps us to save money which can be spent on services elsewhere.

However there are other ways to contact us to report a problem or find out more information:

  • call 0808 800 4005
  • in an emergency dial 999


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