Online Referral Form for Making a Safeguarding Referral


Raising a safeguarding concern:-

When somebody raises a concern about an adult who is believed to have care and support needs and is at risk of or experiencing abuse or neglect (including self-neglect).
Anybody can raise a safeguarding concern by contacting 01983 814980 or by completing the online referral form for professionals.

Who completes this form?

This form is for use by professionals from any agency to raise a safeguarding concern to Adult Social Care about an adult (age over 18) who is believed to have care and support needs and is at risk of abuse or neglect (including self-neglect).

It seems quite a long form – why?

A worker within the Adult Safeguarding Team will use the information in this form to begin to inform a decision as to whether a safeguarding adult’s enquiry is required, and if so, what will happen next, so the information you provide will be crucial to ensuring the right decision is made.

I don’t have all the information – what do I do?

Don’t delay sending in the concern.  We can plan together how key information is to be obtained.  Just note that you ’don’t know’ on the relevant section of the form.

Where can I discuss concerns before making a formal referral if I am unsure whether to refer?

The Adult Safeguarding Team Adults team provide a duty advice service on 01983 814980 in office hours.

What about immediate safety?

The Adult Safeguarding Team aims to respond to concerns as quickly as is required. Please note:this is not an emergency service.
You are asked to consider the immediate safety of the referred person in the form. If you assess that the person is at risk of immediate harm, you need to also alert appropriate emergency or other services to address that risk.

What do I do if the concern arises out of office hours?

If you need support from Adult Social Care to manage an immediate risk please phone the Out of Hours team on 01983 821105.  Otherwise please refer safeguarding concerns in the usual way to

Referrals for Children

If you need to make a referral for a child, please refer to the Safeguarding Children’s Partnership online guidance.

4LSAB Fire Safety Development Group – Case Referral Form

The 4LSAB Fire Safety Development Group is a partnership led by Hampshire & IOW Fire & Rescue to ensure that fire safety risk management is embedded into partner working practices to reduce people being killed or seriously injured in fires. Agencies can refer cases to the Fire Safety Development Group for the purposes of review and learning. Please use the below form, which contains referral criteria.

Visiting Professionals Tool

Care Services Visiting Professional Tool (One for homes and one for Homecare)

Primary Function:

  • Captures feedback within the service, this is intended as multi-purpose for examples of good practice and where improvements may be needed.
  • Used by professional/clinical and other management staff visiting the service, making the most of the opportunity to gather information, open conversations.
  • Short and easy to use, this provides staff with the vehicle for documenting their views.


  • Captures information about environment/ concerns/ staffing levels/residents are well dressed and cared for/calls bells answered etc.
  • Enables feedback to be collated in a more consistent manner and for themes to be identified, where all systems and services may need to focus activities.

Sent to, Collated by:

  • Commissioning team receives and collates information and sends out to the service the form and a rating and response if needed.  ASCCommissioningUnit ASC@IOW.GOV.UK
  • Quality team view responses when received to inform domains on the Quality matrix, which contributes to the services overall risk and quality rating.

Quality and Risk ratings inform:

  • commissioning decisions.
  • Provider improvements.
  • support work that may be required.
  • Wider system developments.

Document Protocol

  • This observation form is for use once per visit, it is for recording general observations, not focused on one individual.
  • The professional is required to discuss with providers, managers or their representatives before leaving the visit.
  • Feedback can be used to demonstrate positive practices that are taking place, as well as quality concerns, that will support the service in continued improvement.
  • The form will be shared with providers, including details of who submitted the form and when, within 5 working days of receipt of the returned form.

Safeguarding Protocol

  • If you have any concerns about the wellbeing of an adult during this visit, please ensure that you take reasonable steps to address any immediate risks and share all concerns with a manager or senior on duty.
  • If you have an adult safeguarding concern (an adult with care and support needs, at risk of or experiencing abuse or neglect and due to their care and support needs is unable to protect themselves from the risk of or experiences of abuse or neglect), please report your safeguarding concerns to a manager or senior on duty and discuss action to take, where possible and appropriate speak to the adult at risk to inform them of your concerns and ascertain their views and wishes.
  • All safeguarding concerns should be reported same day to: