What to do if you are worried about an adult? What does Safeguarding Adults mean?

An adult at risk is a person aged 18 years or over who has needs for care and support.
Safeguarding adults means protecting an adult’s right to live in safety, free from abuse and neglect. Abuse takes many forms and can include everything from physical and sexual harm to discrimination and neglect. Safeguarding is about people and organisations working together to prevent or stop abuse and neglect. Any agency providing care or any member of the public can complete this form, please complete it with as much information as is available.

Any agency providing care or any member of the public can complete this form, please complete it with as much information as is available.

Privacy Notice – whilst it is good practice to gain the consent of the adult when reporting a concern, in the context of safeguarding it is not necessary to seek consent. In situations where the adult, or someone else is at risk, it may be necessary to report the concern without consent. Read our privacy notice, here.

24 hour contact tel no: 0151 443 2600

You can use this number to contact Knowsley Adult and Children’s Social Care during working hours and to help with urgent situations between 5pm and 9am every weekday, weekends and public holidays. A submitted electronic form will not be monitored during these hours.

Dial 999 if somebody needs Police help in an emergency.

If you wish to report a concern about the quality of care that does not meet the criteria for a safeguarding response, please follow this link.

Mandatory fields are clearly marked and must be completed.

Adult at risk details

Full name of adult:

This field is required

Date of birth: Type the date manually (format dd/mm/yyyy) or select date using the date picker

Leave blank if not known

NHS No (if known):

Tel No:

LAS No (if known):

Title:

This field is required

Gender:

This field is required

Ethnic origin:

This field is required

Date and time of incident (if known):

Is the person aware of this referral?:

This field is required

Nature of care/support need for adult:

This field is required

Have you asked the adult their views and wishes in relation to this concern?: If not, you must report anyway

This field is required

Has the person consented to this information being shared?:

This field is required

What does the person want to happen? (making safeguarding personal): Please give details of the person’s wishes (or the wishes of their representative)

Does the person need support with communication?: Please specify:

This field is required

Adult's address:

Accommodation type: (e.g. Own homes, residential\nursing home, supported living, extra care housing, hostel, homeless, other)

If living in a care service please state funding authority:
Please specify:

This field is required

If in a care service please state if adult is temporary or long term resident:

Other agencies involved: (Add as many agencies as required)

Linked agencies

Agency	Name	Tel No	Email
{{x.agencyname}}	{{x.name}}	{{x.telephone}}	{{x.email}}

Other people involved: (Add as many people as required)

Linked people

Name	Relationship	Tel No	Email	Address
{{x.name}}	{{x.relationship}}	{{x.telephone}}	{{x.email}}	{{x.address1}}, {{x.address2}}, {{x.town}}, {{x.postcode}}

Details of the person reporting the concern

This is either yourself or the person who alerted you to concerns about this adult. We need this information so we can contact you to discuss your concerns.

Person reporting concern:

You Somebody else

This option is required

Name:

This field is required

Role/Relationship:

This field is required

Organisation name:

Address:

Telephone:

Email:

Please provide the duty contact details (if applicable) for scenarios where the referrer may not be available (on annual leave, etc)

Duty Telephone:

Duty Email:

Incident/concern details

What type(s) of abuse do you think has occurred/may occur? Select a main category and if there is more than one type of abuse please select the 'Add a sub-category' button to add multiple sub-categories.

Please ensure you press the 'Click to add' button to confirm and add sub-categories.

Main category:

This field is required

Sub category:

Added sub-categories

{{x.SubCategory}}

Location of incident/risk:

This field is required

Other:

Witnesses: (Add as many witnesses as required)

Linked witnesses

Name	Role	Contact
{{x.name}}	{{x.role}}	{{x.contact}}

Description of alleged incident/risk:

This field is required

Source of risk

Do you know who the adult is at risk from?:

This field is required

Who is the adult at risk from?: (Name of person or organisation posing a risk)

This field is required

Any details?: (Address, DOB, approx. age)

Relationship to adult at risk:

This field is required

Is the source of risk also an adult with care/support needs?:

This field is required

Nature of care/support:

This field is required

Your details

Name:

This field is required

Role:

This field is required

Telephone:

This field is required

Email:

Please provide the duty contact details (if applicable) for scenarios where the referrer may not be available (on annual leave, etc)

Referrer Duty Telephone:

Referrer Duty Email:

Organisation & address:

These fields are required

If you are having any issues completing this online form, please contact us on 0151 443 2600.

24 hour contact tel no: 0151 443 2600

Mandatory fields are clearly marked and must be completed.

Successfully submitted referral