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We'll investigate reports of the

  • abuse
  • neglect

against adults who need care or support and because of these needs cannot protect themselves from harm.

We aim to respond to your concern within two working days.

If you’re worried about your own or someone else’s safety and need an emergency response, call the Police on 999. If this isn't an emergency but a crime may have taken place, call the Police on 101.

This is a form for professionals who suspect that an adult in Bristol with care and support needs is at risk of harm from others due to abuse or neglect, or at risk of self-neglect but their health or welfare is not in immediate danger.

Professionals must complete the form as fully as possible. A lack of information may cause a delay and can leave a person unsafe.

If you do not have all the information we are asking for, please gather this before completing this form unless the delay would leave the person you are referring unsafe.

 More about safeguarding adults at risk

Is an urgent response required today?
You need to tick one of the options.
12:28, 21/03/2019

Did the *abuse happen in Bristol?
You need to tick one of the options.*It may also apply to neglect, exploitation or risk of harm

Is the adult you are contacting us about aware of your referral?
You need to tick one of the options
Has the adult given you their consent
You need to tick one of the options.
Missing or incorrect valueIf you feel the person is not fully able to understand the risk, describe why.

You need to tell us your full name.
You need to tell us your job title.
You need to tell us your organisation.
You need to tell us your phone number.
You need to tell us your email address.
This may be helpful if you are likely to be unavailable to contact after submitting the referral e.g. if you job share or work part time.

You need to tell us adult full name.
You need to tell us their address.Include a post code
Include a post code
You need to tell us the adult date of birth.Type dd/mm/yyyy
You need to tell us the adult phone number.If you do not know their number, write yours.
Does the person need a sign language interpreter, large print, translator or do they have other communication needs.
Missing or incorrect value

Would you like to continue with the online form or attach a document with filled in paper form
Missing or incorrect value
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