HYROX - Online Safeguarding Report Form

Please complete the following sections with as much detail as possible regarding the specific welfare or safeguarding concern. Youngstars Lead Safeguarding officer will contact you as soon as possible after receiving the referral. To keep children safe, information may need to be shared appropriately with others. 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, please contact Youngstars Safeguarding Manager at kelly.hounslow@hyrox.com

First Name: * Person reporting the safeguarding concern.

Surname: * Person reporting the safeguarding concern.

Phone: Person reporting the safeguarding concern.

Email: Person reporting the safeguarding concern.

Role:

Persons Involved

Victim

Adult (18+) or Child?

Adult (18+)

Child

Has adult given consent for referral?

Yes

Name of Alleged Victim:

First Name

Surname

Date of Birth:

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

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

Race Number:

Subject of Concern

Name of Subject of Concern:

First Name

Surname

Date of Birth:

Role:

Disability:

Gender:

Male

Female

Race Number:

Address:

Post Code:

Telephone Number:

Email Address:

Incident Details

Date Occurred:

Time Occurred:

Name of Event:

Incident Type:

Category of Concern:

Inside or Outside of Sport:

Describe what happened: Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.

Attachments:

*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 HYROX UK's privacy policy, available at hyroxuk.com/privacy-policy