CONFIDENTIAL
(Version: October 2014) Form
SA2f
Safeguarding Adults
Request For A Case Conference Meeting
Adult At Risk:
Name:
Address:
ESCR ref:
Date of Birth:
Date of Death
(if applicable):
Ethnicity:
Gender:
Language:
Post Code:
Telephone No.
Summary of Safeguarding Concerns/Allegation:
< Guidance Notes: Please complete with the following:
Each alleged type of abuse to be stated (e.g. physical, sexual, emotional/psychological, financial,
neglect (or acts of omission), discriminatory or institutional) as a heading and numbered.
1. Under each alleged type of abuse, list key incident(s) that make up the allegation summarised as
numbered points
2. The estimated time frames for the Investigation Report to be forwarded to the Partnership
Support Unit >
Date of the Safeguarding Referral:
Date(s) of Strategy Meeting and any
Strategy Review Meetings:
Suggested Dates for Case Conference:
Date 1:
Date 2:
Date 3:
Suggested Venues:
Details Of Any Special Instructions or Specific Requirements
Case Conference meeting invites, a copy of the investigation report and minutes will be sent by the
Safeguarding Adults Partnership Support Unit to people listed on the Case Conference Invitees List,
unless advised otherwise here.
Requirements in relation to Invitations:
Requirements in relation to the Investigation Report:
Form SA2f (Version: October 2014)
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Name and DoB of the Adult At Risk:
CONFIDENTIAL
Requirements in relation to circulation of Case Conference Minutes:
Any other special needs or requirements:
Case Conference Invitees:
All people recorded here will be invited directly by the Safeguarding Partnership Support Unit and be
forwarded copies of the Investigation Report and minutes, unless stated in the Special Instructions/
Specific Requirements section:
Name
Relationship/Job Title
Email (or Postal Address) Phone Number
Safeguarding Coordinator
Investigating Officer
Adult At Risk
Person alleged to have
caused harm
Adult At Risk / Person Alleged To Have Caused Harm
If the ‘adult at risk’ is not listed in the Case Conference Invitees Section, please state how their
views will be represented:
If the ‘person alleged to have caused harm’ is not listed in the Case Conference Invitees Section,
please state how their views will be represented:
Form SA2f (Version: October 2014)
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Name and DoB of the Adult At Risk:
CONFIDENTIAL
NB: For the Case Conference Meeting to go ahead, the safeguarding investigation report and
notes or minutes of strategy/strategy review meeting minutes) will need to be received by the
Safeguarding Adults Partnership Support Unit 7 working days in advance of the Meeting. Please
email these to safeguarding.adults@leeds.gcsx.gov.uk
Case Conference Requested by:
Name of Safeguarding Coordinator:
Email Address:
Phone Number:
To be Completed By Case Conference Chair:
Allocated Independent Case
Conference Chair:
Allocated Case Conference
Administrator:
Form SA2f (Version: October 2014)
Date Request Sent:
Date of allocation:
Date of allocation:
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