The Glen Waverley Uniting Church PSALTER
Safe Church Concerns Anecdotal Record
Complete and give to your team leader The completed for should be given to your team leader, who will pass the information onto the Safety Concerns Person. This document is to be kept in a locked filing cabinet
Church Congregation name:
Safety Concerns Person: _ Name of team leader: Age of person report is concerning:
Relationship to the person:
Describe your concerns, what was observed or what was said (It is important to provide as much information as possible, basing your information on facts and observations, without making assumptions or jumping to conclusions or making “value” judgments). .
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. Time and date of the incident or recording
Date:
Time: Name:
Signature: _