Reporting Form for Professionals Child Sexual Exploitation WHEN TO USE THIS FORM: Refer using this form should a non-urgent response be required or to submit information about Child Sexual Exploitation. HALO will acknowledge receipt of the referral via e-mail. If there is no immediate risk to life or property but a police response is required as soon as practicable due to the seriousness of the incident and/or potential loss of evidence, dial 101. If there is an immediate danger to life, risk of injury or crime being committed please dial 999. This form should be used to refer children and young persons and/or suspects and perpetrators. This form should also be used in cases where no victim is known but a person is exhibiting CSE perpetrator behaviours. A separate referral must be completed for each child who is vulnerable to, or a victim of, Child Sexual Exploitation. On completion of the form please e-mail it to Part 1: Referrer’s Details Name Agency Address Telephone E-mail (if not secure please seek guidance from your safeguarding lead) Date Completed Part 2: Child / Young Person’s Details (under the age of 18 years) Family Name Forenames Alternative Names (include nicknames) Date of Birth Address Telephone Parent / Guardian (please provide address if different from above and include date of birth) Ethnicity (see codes at end of referral) School/Education (please include school year if known) Health Worker
Reporting Form for Professionals Child Sexual Exploitation WHEN TO USE THIS FORM: Refer using this form should a non-urgent response be required or to submit information about Child Sexual Exploitation. HALO will acknowledge receipt of the referral via e-mail. If there is no immediate risk to life or property but a police response is required as soon as practicable due to the seriousness of the incident and/or potential loss of evidence, dial 101. If there is an immediate danger to life, risk of injury or crime being committed please dial 999. This form should be used to refer children and young persons and/or suspects and perpetrators. This form should also be used in cases where no victim is known but a person is exhibiting CSE perpetrator behaviours. A separate referral must be completed for each child who is vulnerable to, or a victim of, Child Sexual Exploitation. On completion of the form please e-mail it to Part 1: Referrer’s Details Name Agency Address Telephone E-mail (if not secure please seek guidance from your safeguarding lead) Date Completed Part 2: Child / Young Person’s Details (under the age of 18 years) Family Name Forenames Alternative Names (include nicknames) Date of Birth Address Telephone Parent / Guardian (please provide address if different from above and include date of birth) Ethnicity (see codes at end of referral) School/Education (please include school year if known) Health Worker
hertfordshire_police_cse_reporting_form.docx