Initial professional's enquiry

Consent

As your enquiry is not urgent and you have selected that the child is not at risk of significant harm, consent from the parent or guardian needs to be obtained before an enquiry form is submitted.
Has consent for this enquiry been given?
YesNo

Consent required

Please contact the First Response team for advice:
Phone: 0800 1313 126
Selecting Previous Page will return you to the beginning of the form.

Child's details
Child's name

First name

Last name
Date of birth

Please enter approximate date if not known
Gender
MaleFemale
Ethnicity
Is English their first language?
YesNo
First language
Does the parent or child need an interpreter or signer?
YesNo
Address Line 1
Address Line 2
Town
Postcode
Child's telephone number (if known)
Does the child have any known disabilities?
Are there any other siblings or other children linked to your enquiry that need to be added (maximum of 4 additional children)? If you need to add more than 5 children, please put the information in the additional information area at the end of the form.
YesNo

Second child's details
Child's name

First name

Last name
Date of birth

Please enter approximate date if not known
Gender
MaleFemale
Ethnicity
Is English their first language?
YesNo
First language
Does the parent or child need an interpreter or signer?
YesNo
Does this child live at the same address as the first child? If they have a different address please add the details below.
YesNo
Address Line 1
Address Line 2
Town
Postcode
Child's telephone number (if known)
Does the child have any known disabilities?
Are there any other siblings or other children linked to your enquiry that need to be added?
YesNo

Third child's details
Child's name

First name

Last name
Date of birth

Please enter approximate date if not known
Gender
MaleFemale
Ethnicity
Is English their first language?
YesNo
First language
First language
Does the parent or child need an interpreter or signer?
YesNo
Does this child live at the same address as the first child? If they have a different address please add the details below.
YesNo
Address Line 1
Address Line 2
Town
Postcode
Child's telephone number (if known)
Does the child have any known disabilities?
Are there any other siblings or other children linked to your enquiry that need to be added?
YesNo

Fourth child's details
Child's name

First name

Last name
Date of birth

Please enter approximate date if not known
Gender
MaleFemale
Ethnicity
Is English their first language?
YesNo
First language
Does the parent or child need an interpreter or signer?
YesNo
Does this child live at the same address as the first child? If they have a different address please add the details below.
YesNo
Address Line 1
Address Line 2
Town
Postcode
Does the child have any known disabilities?
Are there any other siblings or other children linked to your enquiry that need to be added?
YesNo

Fifth child's details
Child's name

First name

Last name
Date of birth

Please enter approximate date if not known
Gender
MaleFemale
Ethnicity
Is English their first language?
YesNo
First language
Does the parent or child need an interpreter or signer?
YesNo
Does this child live at the same address as the first child? If they have a different address please add the details below.
YesNo
Address Line 1
Address Line 2
Town
Postcode
Child's telephone number (if known)
Does the child have any known disabilities?

Parent/carer's details
Parent/carer's name

First name

Last name
Date of birth

Please enter approximate date or age if not known
Phone
Email
Does the parent/carer live at the same address as the child? If the address is different, please add the details beow (if known).
YesNo
Address Line 1
Address Line 2
Town
Postcode
Ethnicity
First language

Concerns

If the child is at immediate risk, for example they are home alone now or exposed to drugs now, please call the police immediately. Do not continue with this form.
How would you categorise the risk?
PhysicalEmotionalSexualNeglectHome aloneMissingDomestic violencePerson posing risk to childExposure to drugsExposure to alcoholMental healthOther
If you selected 'Other' please give the details here.
How long is it since you first had these concerns?
When did you last see the child(ren)?
Have you reported your concerns before?
YesNo
If so, who did you report this to?
What advice were you given?
Were you given a reference number? If so please enter it here.
Are you aware of any substance misuse, domestic violence or adult mental health difficulties that affect the family? If so, please enter the details here.
Please tell us anything else you know about the family that may be relevant to the child(ren)'s safety and welfare?
Please explain what has happened, or what you are concerned about?

Upload an EHA
Please ensure that your document is in Word and not PDF format and not handwritten.

This information will need to be legible to inform the referral you are making and so we can input the information into our electronic system.
Please upload current EHA

Current plans and assessments

If you have any plans, reports, or assessments you wish to include to support your enquiry please select Yes.
Are there any other current plans, reports, or assessments?
YesNo

Other documents
Please ensure that your document(s) are in Word and not PDF format and not handwritten.

This information will need to be legible to inform the referral you are making and so we can input the information into our electronic system.
Please upload any Child in Need plans, CP plans and any related reviews.

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