This form is only for professionals. If you are a member of the public please call 0208 726 6400.
If you have concerns about a child or young person, who currently does not have a Social Worker, who you believe is being exploited (sexually or criminally) then please complete the CE screening tool. If, following the completion of the screening tool, you wish to make a referral then the completed screening tool should be submitted with the Multi-agency referral form (MARF) and sent to the Single Point of Contact (SPOC).
Please note: completing this form will take several minutes. You need to ensure you have the child and families details to hand before you start.
Please make sure you have consent prior to filling in this form, unless it would increase the risk of significant harm to a child in doing so. Please note without consent we cannot progress your referrals.
Please ensure you complete all the required fields and press SUBMIT once the form is complete. Once the form has been submitted you will receive a thank you message confirming we have received your referral.
If this form is not working for any reason, please use download and send us the SPOC Referral Form word document, located at the bottom of this link: www.croydon.gov.uk/healthsocial/families/childproctsafe/childprotect
If you are a professional concerned about a child’s immediate safety, please call 999. If you would like to contact the SPOC please call 0208 255 2888.
Child Exploitation Screening Tool
Please Note:
Enter the child's address
The parents/carers/household members (where Y/N please select)
# | First Name | Last Name | Relationship | |
---|---|---|---|---|
{{$index + 1}} | {{item.FirstName}} | {{item.LastName}} | {{item.Relationship}} |
Enter the address
Details of Professionals involved with Child or Family (including GP, School, Health, Worker/Family Worker, etc.)
# | Name | Organisation Name | Organisation | Relationship | |
---|---|---|---|---|---|
{{$index + 1}} | {{item.FirstName + " " + item.LastName}} | {{item.Organisation}} | {{item.OrganisationType}} | {{item.Relationship}} |
Reason for Concern(if your concern is about a vulnerable adult/carer we still need you to complete this section) or any other factors to take into consideration
Is there suspected or history of Mistreatment? Please select Yes or No in the box as appropriate
Using your professional knowledge, please rate the level of risk involved:
Getting parental consent has a significant impact on our ability to respond, particularly if we would like to be able to offer the family Early Help;
- As a referrer working with the child or family, it is your responsibility to speak with the Parent/s or Carer/s about your concerns.
- Specifically we need you to seek consent from parents or carers when making a referral (where this does not put the child at risk of harm).
- If you are unable to obtain consent you must explain why this is not possible.
A) I have spoken to the child's parents or carers to discuss my concerns and they are aware that I am making a referral but have not given their consent
B) I have spoken to the child's parents or carers and they have given me consent to make this referral
C) I have not spoken to the child's parent or carers and I have provided an explanation below as to why this has not been possible
Section 1 - About the child
Section 2 - Details of the family - Father/Mother/other siblings or family members and/or significant others/adults (including perpetrator if applicable)
Section 3 - About You
Section 4 - Details of Professionals involved with the Child or Family (including GP, School, Health, Worker/Family Worker, etc.)
Section 5 - Reason for Concern (if your concern is about a vulnerable adult/carer we still need you to complete this section) or any other factors to take into consideration
Is there suspected or a history of…
Section 6 - Parent or Carer Consent
Getting parental consent has a significant impact on our ability to respond, particularly if we would like to be able to offer the family Early Help;
- As a referrer working with the child or family, it is your responsibility to speak with the Parent/s or Carer/s about your concerns.
- Specifically we need you to seek consent from parents or carers when making a referral (where this does not put the child at risk of harm).
- If you are unable to obtain consent you must explain why this is not possible.
Thank you for submitting a Safeguarding Referral to Croydon’s MASH.
We will make a decision in relation to the status of this referral within one working day. You will be notified of our decision at that point using the email address you have provided.