TEVC Child Protection Incident Report Form

All information will be strictly private and confidential. Team Essex Volleyball Club (TEVC) are fully committed to the welfare of our members and will investigate all reported incidents. TEVC follow the recommended guidelines and procedures of volleyballengland.org/safeguarding.

Your Name (Required):

Your Email (Required):

Your Contact Number:

Position (Required):

Location (Required):

Short Description (Required)

Date Occured

1. CONCERNS Describe your concerns and who they are about, Child or Adult. Give the names and if possible the details of the people involved.

Where and when did the above take place?

Does anyone else know about it? Did anyone else see, hear or make any comment? Give their names and (if possible) their details.

Are these your concerns or a third party's? If the latter, give their name and, if possible, their details.

2. ACTIONS Have you informed the CCWO/Person with overall responsibility for the child? If YES, please state what they said. If NO, please state why not.
Yes, I have informedNo, I have not informed

Please state the above here.

3. WRITTEN STATEMENTS Have you got a written statement from the child involved / any third parties involved? If NO, please state why not.


Please state the above here.