Reported to: Role of person reported to: Signed: Date: Action taken: Advice sought: (from whom and what was advice given) Concern / referral If not, state reasons discussed with parent why – if yes, note / carer? discussion with parent Referral made: If not, state reasons why – if yes, record to whom and any action agreed Feedback to referring By whom member of staff: Response to / action By whom taken with pupil: Name and contact number of key workers: Name and contact details of GP: Other notes / information: Any other action required:
Reported to: Role of person reported to: Signed: Date: Action taken: Advice sought: (from whom and what was advice given) Concern / referral discussed with parent / carer? If not, state reasons why – if yes, note discussion with parent Referral made: If not, state reasons why – if yes, record to whom and any action agreed Feedback to referring member of staff: By whom Response to / action taken with pupil: By whom Name and contact number of key workers: Name and contact details of GP: Other notes / information: Any other action required:
CP_policy_Oct_2018.docx