HomeLADO referral formReading LADO referral form Date of alleged incident(Required) DD slash MM slash YYYY Time of alleged incident Hours : Minutes AM PM AM/PM Date of referral(Required) DD slash MM slash YYYY Contact details for the person making this referralContact name(Required)Contact address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Name of person making this referral(Required)Your phone number(Required)Your email address(Required) Name of agency / organisation(Required)Job title(Required)Details of the person about whom there are concernsName(Required)Date of birth (if known)Gender(Required)Ethnicity(Required)Not knownAsian IndianAsian PakistaniAsian BangladeshiAsian ChineseAny other Asian backgroundBlack BritishBlack CaribbeanBlack AfricanAny other Black, Black British, or Caribbean backgroundMultiple heritage: White and Black CaribbeanMultiple heritage: White and Black AfricanMultiple heritage: White and AsianAny other Mixed or multiple ethnic backgroundWhite English, Welsh, Scottish, Northern Irish or BritishWhite IrishGypsy or Irish TravellerRomaAny other White backgroundArabAny other ethnic groupPlease select from the drop down menuAddress(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Telephone numberOccupation / job title(Required)Organisation(Required)Status(Required)Full timePart timeAgencyEmployment industry e.g. voluntary sectorLength of time employed (in years)Name of manager of alleged personName of regulating body if relevantDo they work in any other capacity with children?Do they have children of their own (under the age of 18)?(Required) Yes No Don't know Is this an allegation about a foster carer?(Required) Yes No Previous concerns about the alleged member of staff that the referrer / employer knows about(Required)Additional needs of the professionalHas there been a previous allegations management record about this professional?(Required) Yes No Not known Details of child or children linked to the allegation / concern (if identified)Name(s)(Required)Date(s) of birth(Required)Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Open to children’s social care?(Required) Yes No Not known Mosaic IDSocial worker's nameIndependent reviewing officer (IRO)Does the child(ren) have a disability?(Required) Yes No Not known Please give details if yesLegal status(Required) UK citizen Settled status (indefinite leave to remain) Pre-settled status (temporary EU settlement) Limited leave to enter or remain Not known Social care status Child protection Child in need Child looked after Child related to a member of staff Details of allegation(s)Detail of allegation or concern(Required)Please include information about where the incident took place, any injury, were there any witnesses (include names) and whether any actions have been takenWho has made the allegation?(Required)Have parents been informed?(Required) Yes No Not sure Parents / carers names(Required)Has the alleged been informed of LADO referral?(Required) Yes No Was the incident reported to LADO within 24 hours?(Required) Yes No If no, why not?Category of harm(Required) Physical Sexual Emotional Neglect Other Incident in Reading Borough area(Required) Yes No Other Is Reading Borough Council the responsible local authority?(Required) Yes No Unsure Referral confirmationYour name(Required)Confirmation statement(Required) I confirm all the details provided in this referral reflect the truth to the best extent of my knowledge Back to LADO information page
