Page 1 of 8 Initial Referral Discussion Minute ...... CONFIDENTIAL

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Note: ALL sections of this document MUSTbe completed /
CARE, LEARNING
& WELLBEING
INITIAL REFERRAL DISCUSSION
MINUTE
(Child Protection Form 5 – CP5)
Name of Children / SWIS Ref No.
Name and unique reference number for each child who is subject to referral
Local Office
Contact Person’s Name
Date of Child Protection Conference
Chairperson
Minute Taker
  1. Children Involved in Investigation

1a.
First Name / 1b.
Surname / 1c.
Date of Birth / 1d.
Gender / 1e.
Home Address / 1f.
Current Address / 1g.
SWIS Ref No.
  1. Parents

2a.
Name / 2b.
Known as / 2c.
Birth Surname
(if different) / 2d.
DOB / 2e.
Address
(If different from Child) / 2f.
Parental Responsibilities
Y
N
Y
N
  1. Other Significant People

3a.
Name / 3b.
DOB / 3c.
Gender / 3d.
Address / 3e.
Rel. to Child / 3f.
Parental Responsibilities
Y
N
Y
N
Y
N
Y
N
  1. Other Significant Children

4a.
First Name / 4b.
Surname / 4c.
DOB / 4d. Address / 4e.
SWIS No / 4f.
Also referred
Y
N
Y
N
Y
N
  1. Child Protection Conference Details:

Details / Name / Designation
Chairperson
Present for all of the proceedings:
Present for part of the proceedings:
Apologies
Reports available
Invited but did not attend
Did not attend but reports sent

6. Summary of discussion (if required use the continuation page provided):

Guidance notes

  • Details of allegations / concerns (CP1)
  • Other agencies – background information
  • General discussion
  • Views of the Children
  • Views of the Parents/Carers
  • Needs Assessment
  • Conclusion re Registration and details of further action required

Introduction

Page 1 of 8 Initial Referral Discussion Minute ...... CONFIDENTIAL

7. / ENDORSED OUTCOMES – Initial Referral Discussion – (Date)
(Name) – (DOB) – (Address)
VISION: The child should be Safe, Healthy, Active, Nurtured, Achieving, Respected, Responsible and Included
The overall long-term aim / purpose of the multi-agency plan for (Name) is…
Lead Professional / Agency / Address / Tel No & E-mail / Date
Planned Outcomes / Action required / Supports proposed / Timescale / Person / Agency Responsible
1.
2.
3.
4.
5.

Page 1 of 8 Initial Child Protection Conference Minute Initial Child Protection Conference Minute ...... CONFIDENTIAL

Date of next Conference/Review: / Confidentiality
The information in this document is confidential to you. It must not be disclosed to any other person or agency without the written consent of the Child Protection Conference Chairperson.
If you disagree with any aspect of this report you should contact the Chair and any discrepancies will be reviewed.
Signature of
Minute Taker:
Date signed:
Signature of Chairperson:
Date signed: