ECC999

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MAKING A CHILD PROTECTION REFERRAL
PRIORITY REFERRALS SHOULD ALWAYS BE REFERRED BY TELEPHONE (Child needs ‘Immediate Protection’).
Daytime Hours (Mon – Thurs 8.45am – 5.30pm, Fri 8.45am – 4.30pm): 0845 603 7627
Out of Hours (Mon - Thurs 5.30pm - 9.00am, Fri 4.30pm – Mon 8.45am Inc. Bank holidays): 0845 606 1212
By Email to:
By Post to: Initial Response Team, Essex House, 200, The Crescent, Colchester, Essex CO4 9YQ
By Fax to: 0845 601 6230 or 01206 844981
Professional Consultation: 0845 603 7627 and ask for the Consultation Line.
Check List
Parent has been informed of the referral. / Referral will be emailed securely.
Child/ren is at immediate risk / has suffered significant harm and Police have been informed.
`ESCB Effective Support for Children & Families` consulted to ensure the most appropriate service has been sought.
REFERRED CHILD/REN / YOUNG PERSON’S DETAILS:
First Name / Surname / DoB/ EDD / Gender / Ethnicity / First Language / Beliefs / Disability Y/N
Any other relevant information e.g. Interpreter/ Signer required; nature of disability:
PARENTS / MAIN CARERS AND OTHER HOUSEHOLD MEMBERS:
Name / DoB / Relationship to child / young person / Ethnicity / First language / Beliefs / Parental Responsibility
Yes / No / NK
/
Yes / No / NK
/
Yes / No / NK
/
Yes / No / NK
/
Any other relevant information e.g. Interpreter/ Signer required; nature of disability:
Child/rens Main address (including postcode):
/ Home Tel no:
Mobile no’s:
Current address if different (e.g. staying with a relative):
/ Home Tel no:
Mobile no’s:
NON-HOUSEHOLD SIGNIFICANT FAMILY MEMBERS & OTHER RELATED PERSONS:
Name / DoB /

Relationship to child / young person

/

Address

/ Tel no: / Parental Responsibility
Yes / No / NK
/
Yes / No / NK
/
Yes / No / NK
/
Yes / No / NK
/
REFERRER’S DETAILS:
Name: / Agency:
Professional Title: / Address (including postcode):
Phone No:
Email address:
(Please use a secure email address or follow your Information Governance Procedures)
Who is requesting a service from Social Care? / Referrer / Parent(s) / Child / Young Person
What is referrer’s current involvement with the family?
INFORMING PARENT(S) OF YOUR REFERRAL:
Is the parent /carer aware of your concerns and the referral? / Yes / No
Which parent / carer has been informed?
If parent / carer is not aware of the referral, please state why:
Are there any safety issues / hazards to be aware of? / Yes / No / Unknown
If yes please specify
AGENCIES INVOLVED WITH THE CHILD/REN / YOUNG PERSON:
Agency / Name / Phone No.
Health Visitor
Midwife
Other Community Health Services
Early Years / Child Care Settings
School
School Nurse
GP
Probation / YOT
Family Solutions
Other
REASON FOR REFERRAL (Refer to ESCB Effective Support Document):
What are you worried about?
What is working well?
What needs to happen?
What are your expectations from this referral / Social Care?
Are you providing any additional information to support this referral? e.g. Assessment / Incident Report
Please state:
This is confirmation of a referral I made by telephone on / (date) To whom
Signature: …..…………….………………………………….. Date: …………..……………………………………
REASON FOR REFERRAL (continuation sheet):