Manager/Officer’s Signature Date OFFICE USE ONLY TO BE COMPLETED AT SECTION 42/ENQUIRYSTAGE – Is the adult’s service funded by? Local Authority Health Self-Funded (please state) Has there been any previous Safeguarding Concerns/Enquiries about this Yes No adult? Please give number of previous Concerns Actions and advice given at the initial enquiry point considered Entered onto Case Management System by Date Time Received by (signature) Date Time GUIDANCE INFORMATION SECTION 2: ETHNICITY Asian / Asian British Black / Black British / Multiple Ethnic White British Indian Black Caribbean Groups White Irish Pakistani Black African / Irish Bangladeshi Any Other Black Traveller Chinese White Other Any Other Asian Other Ethnic Groups Refused Undeclared / Not Known Arab SECTION 4: LOCATION OF ALLEGED INCIDENT/CONCERN Own Home The residence the adult at risk usually lives. Includes property owned/rented by the individual, family or friends. Care Home Nursing – Can be used whether the person is at the care home on a permanent or temporary Care Home Residential – Can be used whether the person is at the care home on a permanent or temporary basis. Supported Living Can include any type of supported accommodation, such as independent living.
Manager/Officer’s Signature Date OFFICE USE ONLY – TO BE COMPLETED AT SECTION 42/ENQUIRYSTAGE Is the adult’s service funded by? Local Authority Health (please state) Self-Funded Has there been any previous Safeguarding Concerns/Enquiries about this adult? Yes No Please give number of previous Concerns Actions and advice given at the initial enquiry point considered Entered onto Case Management System by Date Time Received by (signature) Date Time GUIDANCE INFORMATION SECTION 2: ETHNICITY White British White Irish / Irish Traveller White Other Asian / Asian British Indian Pakistani Bangladeshi Chinese Any Other Asian Black / Black British Black Caribbean Black African Any Other Black / Multiple Ethnic Groups Other Ethnic Groups Arab Refused Undeclared / Not Known SECTION 4: LOCATION OF ALLEGED INCIDENT/CONCERN Own Home The residence the adult at risk usually lives. Includes property owned/rented by the individual, family or friends. Care Home – Nursing Can be used whether the person is at the care home on a permanent or temporary Care Home – Residential Can be used whether the person is at the care home on a permanent or temporary basis. Supported Living Can include any type of supported accommodation, such as independent living.