Concern, Incident, Matter Report (CIMR) Form

Use the Concern, Incident, Matter Report (CIMR) Form if you are concerned about a Student or if there was a Welfare / Wellbeing Incident or if there is a Welfare / Wellbeing Matter about a student.

Concern, Incident, Matter Report (CIMR) Form CRSid of student(s) concerned:

Name of student(s) concerned *:

Student Room (if applicable):

Is the student aware you are submitting this CIMR:
*Please make student aware if appropriate, as per welfare/safeguarding guidelines
Yes
No
Name of person submitting CIMR *:

Email of person submitting CIMR *:

Date of CIMR *:

Time of CIMR *:

Give full description of CIMR *:

Please provide as much detail as possible as to what happened

Describe the action taken to resolve the CIMR *:

Follow Up Required:

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Concern, Incident, Matter Report (CIMR) Form

Concern, Incident, Matter Report (CIMR) Form