Safeguarding Reporting Form

At Middle World Farms, we are committed to the safety and well-being of all participants — especially children, young adults, and vulnerable people. Please use this form to report any safeguarding concern, incident, or disclosure. Provide as much detail as possible. All information is treated with strict confidentiality and delivered solely to our Designated Safeguarding Lead, Martin Robert Taylor. No other team member has access to these submissions.

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1Safeguarding Reporting Form

2Details of the Concern/Incident

3Individuals Involved

4Actions and Assessment

5File uploads and submission

Reporter’s Information

Full Name *

anyone Incident: Location

Role/Position *

Email *

Phone *

Next

Details of the Concern/Incident

Please include all information, no matter how important you think it is

Date of Incident *

Date

Time

Location *

Description of the Concern/Incident

Next

Individuals Involved

Full Name *

Role/Relationship to Incident: *VictimWitnessAlleged PerpetratorOther

What is your relationship to this incident? *

Are there additional individuals involved?

• Yes
• No

Full Name? *

Name of second Person?

Role/Relationship to Incident of second person *VictimWitnessAlleged PerpetratorOther

Any farther individuals involved? *

• Yes
• No

Name and relationship to this incident of anyone else

Next

Actions and Assessment

This section focuses on the steps that have already been taken in response to the incident, your assessment of the situation's severity, and any suggested follow-up actions. Providing detailed and accurate information will help us respond appropriately and take the necessary next steps.

Immediate Actions Taken

Please tell us about any immediate action you feel we need to take.

Level of Concern

• Low
• Medium
• High

How serious would you say this incident was?

Follow-Up Actions

Any other ideas how we can make our Farm safer?

Next

Acknowledgment and Submission

Please review the information you have provided to ensure accuracy. By signing below, you confirm that the details submitted are true to the best of your knowledge. You also acknowledge that this information will be processed in accordance with GDPR and Middle World Farms’ data protection policies. Once ready, click "Submit" to complete your report.

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

Any files or photos in respect to this incident?

GDPR Agreement *

• I consent to having this website store my submitted information so they can respond to my inquiry.

Signature *

Clear Signature

Submit Report