Case Management Panel Recording Form
Part 1
TO BE COMPLETED BY THE DESIGNATED SAFEGUARDING & PROTECTING CHILDREN LEAD OFFICER (CPO)
| LEAD CHILD PROTECTION OFFICER DETAILS | |
| Name |
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| Position |
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| Telephone
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| Mobile
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| Date Referral received
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| Case Number
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| DETAILS OF PERSON(S) INVOLVED IN REFERRAL (the accused) | |
| Position (in relation to young person) | |
| DETAILS OF THE REFERRAL | |
| Date/ time of referral
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| Location
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| Persons involved/ witnesses
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| Nature of referral to include dates/time of concern/incident
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| How did the referral come to your attention?
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| Observations – e.g changes in behaviour, inappropriate actions, injuries, etc | |
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| Record of conversation – details of exactly what was said to you and by you
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| Action taken
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| CONTACTS MADE | |
| Persons contacted
(provide details of name and position and organisation, date and time contacted and any advice received) |
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| SUMMARY |
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| ETHNIC GROUP
Please choose the category that best describes the child’s ethnic group if known, from the following list and tick the appropriate box |
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| White | |||
| A1 British | A2 Irish | ||
| A3 Any other white background | |||
| Mixed | |||
| B1 White & Black Caribbean | B2 White & Black African | ||
| B3 White & Asian | B4 Any other mixed background | ||
| Asian | |||
| C1 Indian | C2 Pakistani | ||
| C3 Bangladeshi | C4 Any other Asian background | ||
| Black or Black British | |||
| D1 Caribbean | D2 African | ||
| D3 Any other Black background | |||
| Chinese or Other Ethnic Background | |||
| E1 Chinese | |||
| E2 Any other (please write in) | |||
| DISABILITY
The Disability Discrimination Act 1995 defines a disabled person as anyone with a “physical or mental impairment that has a substantial and long term adverse effect upon his/her ability to carry out normal day-to-day activities. Please choose the description that best describes the nature of the child’s disability if relevant, and tick the appropriate box. |
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| A Visually impaired | D Learning disability | ||
| B Hearing impaired | E Multiple disability | ||
| C Physical disability | F Other (Please write in) | ||
Part 2
TO BE COMPLETED BY MEMBERS OF THE SQUASH WALES CASE MANAGEMENT PANEL
Is there a case to answer? YES/NO
If YES, should this case be dealt with as a Summary Offence? YES/NO
Do you want to make any recommendations? YES/NO
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Please record the recommendation that have been made to the Lead Officer on the route that this case should follow. Please record the rationale behind the recommendation:
(Please log/attach any additional calls)
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| Details of members of the Case Management Panel involved in making this recommendation:
Name(s):
Signature(s):
Date:
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Part 3
TO BE COMPLETED BY THE LEAD OFFICER
| Details of actions taken and outcome (include all interim actions and outcomes)
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Signed ………………………………………………………………………………………….
Date …………………………………………………………………………………………….
