Safeguarding Adults Initial Enquiry Form for Suspected or Actual Instances of Abuse or Neglect

Safeguarding Adults Initial Enquiry Form
This form is to be used to notify Adult Social Care of suspected or actual instances of abuse or neglect and is the
start of a Safeguarding Adults (Section 42) Enquiry under the Care Act.
This form should be completed as fully as possible in order that robust decisions can be made about the progression,
or otherwise, of the Safeguarding Adults Enquiry.
Person completing the
form:
Role of Person: Helen is the support worker for
Geraldine who is in acute
depression. Helen wants that
Geraldine gets out of depression
and therefore she is helping her to
also cure from her injuries and get
well soon so that she can live happy
life. Helen is taking care of Geraldine
by providing her full support so that
she never feels alone and can get all
the type of helps which she needs at
this stage of her life.
Date of referral to Adult
Social Care:
Organisation:
Phone number: Type of service: The type of service which Helen is
providing Geraldine is the support
service through which the work is
not only done by Geraldine herself
but she gets help in whatever work
she is doing for herself. Through this
support service Helen wants
Geraldine to cure soon and take
care of herself while getting out of
depression quickly.
Details of incident/suspected/actual abuse or neglect
Date of alleged The day since Geraldine met Who reported the
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incident: Michael for curing her from
her depression and injuries
which had during her
accident.
alert/concern?
Time of alleged
incident:
Date of report:
Where did the incident occur?
Details of the adult at risk
Name: Geraldine Howlton Date of Birth:
Telephone: Ethnicity:
Address:
What is the adult’s primary reason for needing care and support? (please tick)
Physical support: Sensory support: Support with memory
and cognition:
Learning disability
support:
Asperger’s syndrome
support:
Autism support:
Mental health support: Geraldine
needs
mental
health
support
Social support (includes
support for carers/substance
misusers):
No support reason:
Other health condition: Please
specify:
Any other details about the
adult at risk:
Yes, Geraldine is being constantly abused by Michael for whom she pays him £150 and she is
not able to say no for which she is facing this difficulty and is unable to share with Helen too.
Details of the alleged perpetrator (where relevant)
Name: Relationship to victim:
Date of birth: Ethnicity:
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(1) Please give a detailed description of the incident (including times), all people involved, witnesses and any other
comments you feel are relevant. If the concern relates to physical abuse please provide a body map.
(Maximum 200 words)
The incident which happened to Geraldine was a mental abuse in which she was already suffering from mental abuse and this
did not helped her in any way. Geraldine had an accident with her boyfriend which made her body immovable and along with
this she drew herself into depression. Helen a support worker was appointed for her wellbeing and to take care of her. One fine
day, Helen took Geraldine in a holistic conference where she met Michael Fullerton. She told Michael about her past and
Michael ensured that he would help her get rid of the problem which is depression and the physical pain which she was suffering
(Mathews and et.al., 2019). But it turned all opposite, Michael instead of helping her out, continuously took money £150 from
her which led Geraldine into more depression. Helen also did not understood that why Geraldine was giving £150 with no
treatment. The people involved in this incident are Geraldine, Helen and a manager which along with Helen had a conversation
with Geraldine. Michael is the main culprit in the case as this is being seen on the effective grounds how he is abusing Geraldine
and not helping her as promised to get her out of depression and physical injuries which she had.
Type of abuse (tick all that apply):
Physical Sexual Psychological/emotional 
Financial/material  Neglect/omission Discriminatory
Organisational/institutional Self-neglect Domestic abuse/violence
Modern slavery Radicalisation/extremism Other
If other, please specify:
Is the victim at risk of further abuse/neglect? (please tick) Yes

No Unknown
(2) What has been done to ensure the immediate safety of the alleged victim(s) and others? Completing and submitting
this form does not constitute management of immediate risks. (Maximum 200 words)
Till now nothing has been done for the immediate safety and precautions for which Geraldine is to taken care of. Me as a
manager along with Helen is going to have a conversation with Geraldine that what problem is she facing and cannot get rid of.
This will solve the problem at some level but for the other problems which Geraldine is facing that is injuries and depression
which is becoming difficult for her to come out from (Krishnan and et.al., 2019). She is from the problem of Michael is
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becoming more depressed and through this she is unable to take care of herself and focus on what is important for her health.
Therefore, the main problem which Geraldine is going through can make her weaker and for this she is needed immediate care
and safety so that Michael is not able to trouble her because she is facing mental health problems more and for further safety
risk cannot be taken that it is heard that she is facing physical abuse also. Therefore, it is Helen and me will help her get out of
this problem as soon as we can and make Geraldine’s life better so that she comes out of all the problems which she is facing.
Were the Police called? Yes No 
Please provide the outcome of the Police action and Police log number (if available):
If the incident relates to domestic abuse/violence, has the MARAC
Checklist (CAADA-DASH) been completed?
Yes No
If yes, has a referral to MARAC been considered?
Please provide details, including discussions with your agency’s
Single Point of Contact (SPOC) for MARAC:
Yes No
Please provide details of other agencies involved that will be able to help with the safeguarding adults enquiry:
Are you aware that there have there been any previous referrals made in relation to
this adult at risk or alleged perpetrator?
Yes No
If yes, please provide details (e.g. dates, type of abuse, action taken):
Are there any risks to others (other adults, children)? Yes  No Unknown
Please provide details (also include who this information has been shared with – e.g. Police, Children’s Social Care,
MAPPA). If there are risks to children you must notify Children’s Social Care.
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