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Adult Social Care(1)

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					                                                                                                   Form SA2




Safeguarding Vulnerable Adults
Type 1 Service Provider Report
Details of service user
Name:
Address:                                                              ESCR ref:
                                                                      Date of birth:
                                                                      Ethnicity:
                                                                      Client group
                                                                      Telephone:
Date of investigation:

Summary of presenting concerns
Risks to service users/risk to others




 Summary of investigation
 To include: Who consulted, Discussions with service user, carer, staff




                                          Form SA2 Page 1                              Last updated 20th July 2009
                                                                                                   Form SA2


Details of action to address concerns
Reduce risks; likelihood of reoccurrence of abuse; timescales of action; the provider manager’s view on
the outcome of the investigation; whether a different type of investigation needs to be considered; copies
of relevant documents, such as, incident report




Outcomes of actions and who was notified
Action                                                                 By Whom                      Date




                                            Form SA2 Page 2                            Last updated 20th July 2009
                                                                                           Form SA2

Service user’s views of the investigation and outcome




Name of Provider Manager:
Address of Provider Manager:




Signature:
Date:
       This form should be returned to the Safeguarding Coordinator within 14 days


To be completed by the Safeguarding Coordinator
Investigation completed?                                                 Yes       No
Further action needed? (if yes detail below)                             Yes       No




Conduct a further investigation?        Yes    No            Type:   PLEASE SELECT
Name of Safeguarding Coordinator
Signature:
Date:
 A copy of this form should be returned to the Provider Manager for information after the
                   Safeguarding Coordinator has completed this section




                                           Form SA2 Page 3                     Last updated 20th July 2009

				
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posted:9/24/2012
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Lingjuan Ma Lingjuan Ma
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