Referral Form/Record of Initial Consultation
Local Authority Designated Officer (LADO)
NB: It is the responsibility of the LADO or the Independent Chair acting as the LADO,
to check and collect any missing identifying details in relation to the Staff member and
the child at the first Allegation Against Professional(s) (AAP) meeting and to update
the database.
Details of the Referrer
Name:
Agency:
Role:
Tel:
Mobile:
Email: Address:
Date of Referral or Consultation:
Referral received by (email, t/c etc):
Details of Staff member
Name:
Date of Birth:
Gender:
Ethnicity:
Home Address:
Agency:
Job title/role:
Any previous concerns:
Framework ref:
Does Staff member have children in their care that need to be
considered ?:
Type of employer (education, health etc.):
Details of Child
Name:
DOB:
Gender:
Ethnicity:
Disability:
Home address:
Is child known to CYPS?:
Frameworki ref:
Nature of CYPS involvement:
If currently an open case, Allocated SW:
Date of Incident:
Details of Allegation
Actions following initial consultation
Action to be taken by LADO (i.e. set up AAP meeting)
Name of LADO (or Independent Chair acting as LADO):
Date: