People in Positions of Trust referral form

Before you begin

Before you begin, please ensure you've read about how to raise a concern about People in Positions of Trust (PiPoT).

When completing this online form you'll need to know certain information, some of which is 'required', meaning you can't continue the form without it.

Gather the following details in the first instance:

• title, name and address (including postcode), telephone number and email address of person in a position of trust
• whether the person is aware you are raising this concern
• details of children who live with the person in the position of trust
• details of the employer of the person in the position of trust (name, organisation, telephone number, email address, and line manager if known)
• information about who is potentially at risk from this person
• information about the allegation or concern, including details of any injuries
• the date the concern occurred, and when you became aware of it
• details of any action taken to ensure the safety of adults or children at risk, including whether the police been informed if a crime is suspected (including a police log number, crime number or occurrence number)
• your own contact details (name, telephone number and email address)