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Adult Social Care Safeguarding Adults Referral Form

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Adult Social Care GDPR

The information that you provide to us will be used for the specific purpose of fulfilling the request/application you are completing and any subsequent administration required as part of that process. 

It may also be used for management information and statistics to assess the service and measure future provisions. All of your information is processed in accordance with any applicable data protection legislation and regulations. 

For full details on how we use, store and share your information please view the council's privacy notice relating to Adult Social Care.

The personal data provided about you and others on this form may be shared with the individual or their representative.  If you have reason for making the referral in confidence please provide full details on page 5. 

As a professional you should discuss your intention to make a referral with the adult and seek their consent to do so. A refusal to give consent does not mean you cannot refer, especially in cases where; there is a risk or harm to the wellbeing and safety of the adult or others; other adults or children could be at risk from the person causing harm; it is necessary to prevent crime or if a crime may have been committed; the person lacks capacity to consent.  

There will be occasions where speaking to the adult could put them at further or increased risk of harm. This could be, for example, in a domestic abuse situation. The safety of the adult and the potential for increasing the risk should always be considered when planning to speak to the person. Any such situations where there is the potential for endangering safety or increasing risk should be assessed carefully and advice taken from your line manager, or from an external agency as appropriate.  

I have read and understood the above statement* Required


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