Making a Safeguarding Report

This is a structured template for a Confidential Report to raise a concern about a possible sexual abuse or misconduct in activities of the Prelature of Opus Dei in the Region of North-West Europe (Great Britain, Ireland, The Netherlands, Scandinavia).

A copy of the template for a written report can be downloaded as a Word document for editing. The content of the template is shown below. It is not necessary to have all the information requested before submitting a report. Please submit the completed report by email to the Safeguarding Coordinator.

If you prefer, you may provide the equivalent information online in a confidential form using a Google account.

Safeguarding Report

A. This Report is submitted by:

First and last name:
Address:
Eircode:
Phone:
Email:

B. Possible abuse or misconduct. Please provide below (or another page) as much of the following information as possible

Date(s) and time(s) of alleged acts or behaviour
Place(s) / address(es) where the behaviour occurred
Nature of the alleged act(s) or concerning behaviour
Any other information you consider important (e.g., if there was use of violence, threats, making gifts, possible grooming, scandal, abuse of authority, etc.)

C. Suspected perpetrator(s):

First and last name:
Address:
Eircode:
Phone:
Email:
Male 🔲 Female 🔲

Age Now:
Age when alleged abuse took place:

D. Victim (if identified):

First and last name:
Address:
Eircode:
Phone:
Email:
Male 🔲 Female 🔲
Age Now:
Age when alleged abuse took place:

E. Parents / Guardians - (if the victim is still a minor or equivalent):

First and last name:
Address
Eircode:
Phone:
Email:

F. Eyewitness(es) of the possible abuse or misconduct: (use another sheet, if necessary)

First and last name:
Address
Eircode:
Phone:
Email:

First and last name:
Address
Eircode:
Phone:
Email:

First and last name:
Address
Eircode:
Phone:
Email:

G. Others with direct knowledge of the possible abuse or misconduct:

First and last name:
Address
Eircode:
Phone:
Email:

First and last name:
Address
Eircode:
Phone:
Email:

Signature:

Date: