RYA Online Safeguarding and Equality Referral Form

Please complete the following sections with as much detail about the specific safeguarding or equality concern or allegation as soon as possible. A member of the RYA Safeguarding and Equality Team will contact you within 48 hours of receiving the referral, however if a child or adult is in immediate danger or a hate crime has been committed, please contact the police immediately. To keep children and adults safe, information may need to be shared appropriately with other entities*. However, confidentiality will be maintained where appropriate and to ensure that only those who need the information are made aware of it. If you have any queries or concerns about the information you are providing, for safeguarding referrals you can contact the RYA Safeguarding team on 02380 604226 / safeguarding@rya.org.uk and for equality referrals you can contact the RYA Equality Team on 02380 604249 / equality@rya.org.uk

Name: *

Role:

Phone:

Email:

Persons Involved

Victim

Adult or Child?

Adult

Child

Has adult given consent for referral?

Yes

Name of Alleged Victim:

Age:

Phone: Contact Details for Victim’s Parent/Carer/Appropriate Adult

Email: Contact Details for Victim’s Parent/Carer/Appropriate Adult

Subject of Concern

Name of Subject of Concern:

Age:

Role:

Qualifications Held:

Address:

Actions already taken: Are you aware of any local authority /police involvement in this case? If yes, please provide details

Is the RYA Safeguarding Team aware of this referral? If yes, which member of the team have you spoken with

Incident Details

Date Occurred:

Time Occurred:

Name of Club:

Incident Type:

Category of Concern:

Inside or Outside of Sport:

Describe what happened: As much detail as possible. (Facts not suppostition)

Conflicts of Interest: Do you have any relationship with anyone involved in this case which could cause a conflict of interest in any investigations? If yes, plase describe your relationship

*The information you have provided on this form will be used for the purposes of recording your concern. The legal basis for processing this information shall be legitimate interest. The information you provide will be used and stored in accordance with the RYAs privacy policy, available at www.rya.org.uk/go/privacy