MULTI-AGENCY SAFEGUARDING HUB CHILDREN'S REFERRAL Please complete the form below to report concerns about the welfare or well-being of a child or young person. If you have concerns about the immediate safety of a child or young person a referral should be made urgently by telephoning the police or the Multi-Agency Safeguarding Hub (MASH). Please note that for security reasons this form times out after 30 minutes. Any information in partially completed forms will be lost after this time. To avoid this, please complete the form, and press submit within 30 minutes. CONTACT DETAILS If you suspect a person is at immediate risk of harm, call 101 (999 in an emergency) and speak to the Police. To report a safeguarding concern, call the MASH on: Telephone: 0161 770 7777 e-mail: child.mash@oldham.gov.uk You can contact the MASH from 8:40am – 5:00pm on Monday – Friday. For urgent concerns outside office hours, please call the Emergency Duty Team on 0161 770 6936, or the Police on 101 (999 in emergencies).
CHILD/YOUNG PERSONS DETAILS Name   Previous Names/Also Known As Gender Contact Tel No Date of Birth or Est. Date Delivery     Date Received   Address   Ethnicity Religion Disability registered? Is an interpreter or signer required? Has this been arranged? Asylum Seeker? Are there any siblings? No of Parent/Carers
PARENTS OR CARERS - 1 Name   Contact Tel No   Relationship   Ethnicity Address   Parental responsibility Preferred language
PARENTS OR CARERS - 2 Name   Contact Tel No   Relationship   Ethnicity Address   Parental responsibility Preferred language
REASON FOR REFERRAL Reason   Referred by   Address   Role   Organisation   Email     Telephone   Fax  
KEY AGENCIES Details Telephone Details Telephone Details Telephone Details Telephone Details Telephone Details Telephone
NEEDS AND FACTORS Childs Development Needs: Health/Education/Emotional/Social presentation and Relationships   Safety/Basic Care/Stimulation/Emotional Warmth & Boundaries Parents Ability To Meet The Needs Of The Child   Wider Family And Environmental Factors Housing/Resources/Financial Resources & Family Support   What Outcomes Are You Wanting The Social Care team To Achieve  
PARENT AWARENESS Is the Parent/Carer Aware Of This Referral? Parents Comments CAF Completed Date  
SUBMIT Thank you for taking time to complete this referral form. Please answer the simple sum below and press the submit button below to send this referral. 0 + 8 = This is for security purposes