National Guidance for Child Protection Committees for Conducting a Significant Case Review

Annex 1: Exemplar: Initial case review notification

Official-Sensitive-Personal (once completed)

The designated person within any agency should complete this initial case review notification and send it electronically by e-mail to the local CPC lead as soon as possible and in any case within 7 calendar days of first informing the agreed lead.

The CPC lead, on receipt of the written notification should alert other services/agencies/practitioners who are involved with the child that the case has been reported as a potential SCR. This alert to other services/agencies/ practitioners can be by telephone, e-mail or fax etc. These other services/agencies will then be asked to submit an initial case review report by the CPC lead. The CPC lead will acknowledge all initial case review notification reports.

Child's name/identifier:

Child's date of birth:

Child's gender:

Name of child's parents/carers:

Parent/Carer address if different to child:

Sibling names/DOB/Gender/Address if different:

Child's home address:

Child's current residence:

Child's current legal status:

Is the child's name currently on the child protection register? Are any siblings currently on the child protection register? YES/NO

Has the child's name previously been on the child protection register? Have any siblings previously been on the child protection register? YES/NO

Education establishment details:

Grounds on which the criteria for an SCR may have been met (refer to page 9):

Are there any immediate concerns? If so, what are these and have these been passed to the relevant agency for consideration/action?

What action has been taken?

Are there any general concerns? If so what are these and have they been passed to the relevant agency/service for consideration?

Summary of the case:

Name of service/agency/professionals involved with the child:

Any other proceedings underway: