Confidential incident reporting

Speak up safely.
We will listen.

Use this form to report a safeguarding concern involving a child or vulnerable adult. No account is required.

Your information is confidential. Whistle-blowers are protected under the HDCS Whistleblowing Policy. Only authorised staff can view submitted reports.

Report details

रिपोर्टको विवरण

Date of report *रिपोर्टको मितिTime *समयLocation *स्थान

Step 1 of 6

Child / vulnerable adult

बालबालिका / असुरक्षित व्यक्तिको विवरण

Name नामAge and gender उमेर र लिङ्गAddress ठेगानाSchool (if relevant) / education level विद्यालय / शिक्षा स्तरOccupation पेशाAny disability कुनै पनि असक्षमताAlias उपनामOther information अन्य

Step 2 of 6

Person reporting the concern

रिपोर्ट गर्ने व्यक्तिको विवरण

Name *नामAddress ठेगानाContact number *फोन नम्बरOccupation पेशाRelationship to child / vulnerable adult सम्बन्ध

Step 3 of 6

Details of the report

प्रतिवेदनको विवरण

Details of alleged perpetrator पीडकको विवरणAge and gender उमेर र लिङ्गRelationship to child / vulnerable adult सम्बन्धOccupation पेशाCurrent situation हालको अवस्थाPresenting problems प्रस्तुत समस्याहरूSafety concerns सुरक्षाPhysical health शारीरिक स्वास्थ्यPsychological wellbeing मनोवैज्ञानिकSocial concerns सामाजिकOther concerns अन्यDetailed description of concern, allegation or complaint *सरोकार, आरोप वा गुनासोको विस्तृत विवरणIncident date घटनाको मितिIncident time समयLocation of incident घटना भएको स्थानIncident that occurred घटेको घटनाWitnesses (if known) साक्षी

Step 4 of 6

Report recipient details

प्राप्तकर्ताको विवरण

Name *नामPosition पदDate *मितिContact *सम्पर्कSignature (type your name) हस्ताक्षर

Step 6 of 6