appendix 1 incident record form clay pigeon shooting association ltd. child & vulnerable adult...
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Ulster Clay Pigeon Shooting Association Ltd.
CHILD & VULNERABLE ADULT PROTECTION POLICY IN CLAY TARGET SHOOTING
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Appendix 1
Incident Record Form
Child’s details
Your details:
Name:
Appointment:
Address
Childs details:
Name: Date of birth:
Gender: Race or Ethnic origin:
Childs address:
Parents address:
Disability if applicable:
Details of person accused
Name: Age:
Position in sport: Relation to Child:
Address:
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Incident Record Form
Pol
Incident:
What action have you taken so far?
Police
Contact name and number:
Details of advice given:
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Social Services
Contact name and number:
Details of advice given:
Governing Body
Contact name and number:
Details of advice given:
Local council
Contact name and number:
Details of advice given:
(Other e.g. NSPCC)
Contact name and number:
Details of advice given:
Please send a copy of this report to all the agencies involved. Maintain confidentiality as
appropriate and do not discuss this incident with anyone other than those who need to know.
Signature:
Date:
Return copy to: Marked ‘Private & Confidential’ to the Chief Executive Officer of UCPSA
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Appendix 2
Authorisation to Take Photographs or Record Images
Event Details
Event Title:
Date:
Declaration
I wish to take photographs or record images at this event. I agree or abide by the organisers
guidelines and confirm that the photographs or recorded images will only be used for the stated,
appropriate purpose.
Signed:
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Policy Statement Relating to Photographs or Recorded Images
Please return the completed form to the event organiser/club official. You may be asked for proof of
identity.
_____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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Appendix 3
Permission Form for the use of Photographs or Recorded Images
Event details
Event Title:
Date:
Purpose of Photography or Filming
In accordance with our child protection policy we will not permit photographs, video or other images of
young people to be taken without the consent of the parents/carers and the child. The UCPSA will follow the
guidance for the use of photographs and videos, a copy of which is available from (member of staff
responsible). The (organisations name) will take all steps to ensure these images are used solely for the
purposes they are intended. If you become aware that these images are being used inappropriately you
should inform (insert organisations name) immediately.
Consent information:
To be completed by parent/carer:
organisations name) photographing or videoing my child (child’s name)
photography and videoing policy.
the organisation’s will use these images or
videos in future and how these images or videos will be stored within the organisation.
To be completed by child:
child’s name) consent to (organisations name) photographing or videoing my involvement in sporting
activities.
Print name child/young person:
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I _______________(child’s name) consent to UCPSA photographing or videoing my involvement in
sporting activities.
policy.
Signature of child/young person :
Print name child/young person:
Date:
Signature of parent /carer:
Print name parent/carer:
Date:
_________________________________________ _________________
Clubs and Associations – please retain this document
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Appendix 4 Accident Report Form
1. Site where accident took place: .....................................................................
2. Name of person in charge of session / competition: .............................................
3. Name of injured person: ..............................................................................
4. Address of injured person: ...........................................................................
................................................................................................................
5. Date and time of accident: ...........................................................................
6. Nature of accident: ....................................................................................
................................................................................................................
7. Give details of how and precisely where the accident took place. Describe what activity was taking place, e.g. training event, getting changed, etc.
................................................................................................................
................................................................................................................
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8. Give full details of action taken including any first aid treatment & the name(s) of the first aider(s):
................................................................................................................
................................................................................................................
9. Were any of the following contacted: ............................................................... Police: Yes No
Ambulance: Yes No
Parent/guardian: Yes No
10. What happened to the injured person following the accident? (e.g. went home, went to hospital, carried on with session)
................................................................................................................
11. All of the above facts are a true and accurate record of the accident.
SIGNED: ........................................................ DATE: ...................................
Name: .......................................................................................
Please Return to : UCPSA Secretary, 60 Shankbridge Road, Ballymena, County
Antrim, BT42 3DL
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Appendix 5
Useful contacts
Trevor Wilson
6B Cairn Gardens Crumlin Co. Antrim BT29 4UZ Tel. 028 9445 3009 Mob. 07768188421 Email: [email protected] Social Services (children) Each Child Protection Officer must retain their local gateway contact number. Each trust will have a Gateway team to deal with reports of abuse and also more local contacts for on- going professional liaison for advice on concerns. Northern HSC Trust Tel: 03001234333 South Eastern HSC Trust Tel: 03001000300 Southern HSC Trust Tel: 08007837745 Belfast HSC Trust Tel: 028 90 507000 Western HSC Trust Tel: 028 71314090 Regional Emergency Social Work - available 5.00 PM – 9.00 AM Monday to Thursday and 5.00 PM on Friday to 9.00 AM on Monday. There is a 24 hour cover over public holidays. 028 9504 9999 Social Services (vulnerable adults) Northern Health and Social Care Trust 9am to 5pm – 028 2563 5558 Out of hours – 028 9504 9999 South Eastern Health and Social Care Trust 9am to 5pm – 028 9266 5181 extension 4544 Out of hours – 028 9504 9999
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Southern Health and Social Care Trust 9am to 5pm – 028 3083 2650 Out of hours – 028 9504 9999 Belfast Health and Social Care Trust 9am to 5pm – 028 9056 5707 Out of hours – 028 9504 9999 Western Health and Social Care Trust 9am to 5pm – 028 7131 4090 Out of hours – 028 9504 9999 Police Service of Northern Ireland Emergency 999 Non-emergency and general enquiries 0845 0600 8000 Helpline numbers Action on Elder Abuse helpline – 0808 808 8141 Other sources of advice The Older People’s Advocate – 028 9031 6383 Child Protection in Sport Unit NSPCC Regional Centre Address: Jennymount Business Park, North Derby St, Belfast, BT15 3HN Phone: 028 90351135 www.thecpsu.org.uk
Childline
Lanyon Building
Jennymount Business Park
North Derby Street
Belfast, Co Antrim, BT15 3HN
Tel: 0800 11 11
http://www.childline.org.uk
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Access NI
Tel: 0300 200 7888
www.nidirect.gov.uk/accessni
Sport Northern Ireland
House Of Sport, Upper Malone Road
Belfast, County Antrim BT9 5LA
+44 28 9038 1222
www.sportni.net
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Appendix
6
Parental Consent Form for Activities away from home.
Anything written on this form will be held in confidence. Our coaches need to know these details in order to meet the specific needs to your son/daughter. I give permission for my son/daughter to attend training sessions and competitions.
SON/DAUGHTER’S FULL NAME:
…………………………………………………………………………………………………
ADDRESS:
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
HOME TEL: ……………………………… AGE: ………………………………………
DATE OF BIRTH: …………………… MALE/FEMALE (Please Circle)
NAME OF FRIEND ATTENDING: …………………………………………………………
EMERGENCY TEL (1): ………………………… (2): ………………………………
IF UNAVAILABLE CONTACT: ……………………………………………………………
TEL: ………………………… RELATIONSHIP TO CHILD: ……………………
NAME AND TEL OF G.P.: ………………………………………………………………….
CHILD’S MEDICAL NUMBER: ………………………………
DETAILS OF ANY KNOWN ALLERGIES, CONDITIONS, MEDICATION BEING TAKEN:
…………………………………………………………………………………………………
…………………………………………………………………………………………………
I will inform the coaches of any important changes to my son/daughter’s health, medication or needs
and also of any changes to our address or phone numbers given.
In the event of illness, having parental responsibility for the above named young person, I give
permission for medical treatment to administer where considered necessary by a nominated first
aider, or by suitably qualified medical practitioners. If I cannot be contacted and my son/daughter
should require emergency hospital treatment, I authorise a qualified medical practitioner to provide
emergency treatment or medication.
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I have been made aware of that the UCPSA have developed a Safeguarding
Policy & Procedures and they are committed to ensure the safety of
child/young person by having:-
• A Code of Conduct for Participants.
• A Code of Conduct for Parents/Guardians.
• Clear recruitment procedures which includes vetting all coaches/
instructors.
• Guidelines on Photography and Consent Form.
• An Anti-bullying Policy.
• Complaints/Disciplinary Procedures.
• A Child Protection Officer.
The UCPSA/club is committed to ensuring that any information gathered in
relation to our youth academies meets the specific responsibilities as set out in
the Data Protection Act 1998. The UCPSA/club will store the above information
on their competitors’ database for a maximum of 12 months before re-
registering the competitor if still associated with the sport.
Parental Consent (to be signed for competitors under 18 years)
I, ___________________________ being parent/guardian of the above named
child/young person hereby give permission for the nominated Club Official/First
Aider to give the immediate necessary authority on my behalf for any medical
or surgical treatment recommended by competent medical authorities, where
it would be contrary to my son/daughter’s interest, in the doctor’s medical
opinion, for any delay to be incurred by seeking my personal consent.
Name: ____________________________________________
Signature:_________________________________ Date: _____________
(Consent by parent/guardian)
NB: A young person can give their own consent for medical treatment if they
are over 16.
Please return this form to the relevant Child Protection Officer
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Appendix 7
Guidance for this recruitment procedure has been taken from:
The Code of Ethics and Good Practice for Children’s Sport
Our Duty to Care DHSSPS 2012
Getting it Right DHSSPS 2012
Safeguarding Vulnerable Groups (NI) Order 2007
Protection of Freedoms Act 2012
Shooting Guidelines
Access NI guidance www.nidirect.gov.uk/accessni
1. Recruitment of Volunteers
UCPSA relies heavily on the time and commitment freely given by volunteers, and
without this, the opportunities for children and young people to participate in
shooting would not exist. The procedures outlined below will be adopted by UCPSA
for its own purposes and must be followed by clubs for whom UCPSA acts as an
umbrella body. UCPSA will ensure that it has an open and fair recruitment process
for any of its representative roles or any paid positions in the future.
All Coaches and Safety Officers who are likely to come in regular contact with
young people, are to be cleared by Access NI
UCPSA will ensure good recruitment procedures by:
Defining the role the individual is applying for.
Insisting that a person applying for any post of responsibility within the club complete the relevant sports application form.
Obtaining 2 references in writing, (the request for references will only be sought for preferred applicants).
Ensuring that the individual completes and signs the Access NI Disclosure Certificate Application Form which gives permission to enable NIFSS to request an Access NI check (proof of identity MUST be provided). Access NI Forms can be downloaded from www.nidirect.gov.uk/accessni. The forms of identity required are to be presented to a club official who will then sign the Verification Form.
Ensuring that Coaches renew their licenses with the relevant Governing body at the appropriate intervals. Their cards are to be available for inspection when requested.
Setting a probationary period (six months for staff or long-term volunteers).
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Interview/meet the individual either formally or informally. Have two designated members (positions to be identified by the sport) doing this to enable you to;
Assess the individual’s experience of working with children or young people and knowledge of safeguarding issues.
Assess their commitment to promoting good practice.
Assess their ability to communicate with children and young people (i.e. be approachable). One way of doing this is to consult young people or ask questions to examine how a person would respond to a particular scenario e.g. are they authoritarian or too relaxed in their approach.
Ensuring that the Management committee ratifies appointments.
Ensuring that the recruitment process is Open and Fair and does not depend on gender, colour or religion but only on attributes relevant to shooting.
Information from Access NI will be received by the individual and the governing
body (though under the Protection of Freedoms Act only the individual applicant
will receive a copy of the certificate.
For further detailed information on Access NI please visit
www.nidirect.gov.uk/accessni
Persons who will be expected to undergo Access NI Checks:
Any paid employees in regulated activity.
Anyone given the role of Child Protection Officer
Any Coach who may be asked to coach young people
Any UCPSA club Safety Officer who will provide supervision of young people.
Any other person who may help with the supervision of young people at any UCPSA
affiliated club activity and be in regulated activity.
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VOLUNTEER APPLICATION FORM FOR THOSE IN REGULATED ACTIVITY
All information received in this form will be treated confidentially
Name:
Address:
Date of Birth: National Insurance
No:
Telephone No: Mobile No:
Previous work
experience and
relevant
qualifications:
Have you previously
been involved in
voluntary work?
If yes, please give
details:
Yes No
Do you have any spare
time hobbies,
interests or specific
skills that may be
useful to the
activities?
Do you agree to abide by UCPSA Code of Conduct
(a copy should be included with this form)?
Yes No
Have you completed Safeguarding Awareness
Training?
Yes No
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If yes
Organised by:
When:
Do you agree to undergo specific training on the
role of the (position being appointed)
Yes No
Have you ever been asked to leave a sporting
organisation in the past?
(if you have answered yes we will contact you in
confidence)
Yes No
Any other relevant
information?
Please supply the names of two responsible people whom we can contact and who
from personal knowledge are willing to endorse your application. If you have had a
previous involvement in a sports club one of these names should be that of an
administrator/leader in your last club/place of involvement.
Name:
Address:
Telephone:
Designation:
Name:
Address:
Telephone:
Designation:
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DISCLOSURE OF CRIMINAL CONVICTIONS
FOR THOSE WORKING/VOLUNTEER IN NORTHERN IRELAND Please read this information carefully
Statement of non-discrimination
This club is affiliated to UCPSA and is committed to equal opportunity for all applicants including those with criminal convictions. Information about criminal convictions is requested to assist the selection process and will be taken into account only when the conviction is considered relevant to the post. Any disclosure will be seen in the context of the job criteria, the nature of the offence and the responsibility for the care of existing members, volunteers and employees. For the purposes of your application for the post of: ______________________________________________________________ We require all coaches/volunteers in positions of responsibility for managing the safety and development of young people to sign the declaration and return it marked confidential to UCPSA Secretary, 60 Shankbridge Road, Ballymena, County Antrim, BT42 3DL Should you require further information, please contact UCPSA Child Protection Officer Trevor Wilson Tel. 028 9445 3009 Mob. 07768188421 Email: [email protected] .
NAME OF APPLICANT: _________________________________________________
HOME ADDRESS _________________________________________ ________________________________________________________ CONTACT TELEPHONE NUMBER ___________________ CLUB/ORGANISATION: _______________________________________________ Please read this information carefully The purpose of the check is to make sure that people are not appointed who might be a risk to children or vulnerable adults. The check will tell us whether you have a criminal record, or whether any other information about you held on barred lists may have a bearing on your suitability. Any information which we receive will be treated confidentially, and will be discussed
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with you before we make a final decision. After that decision is made the information returned from AccessNI will be destroyed. Advice to Applicants You have applied for a role which falls within the definition of an “excepted” position as provided by the Rehabilitation of Offenders (Exceptions) Order (NI) 1979: therefore ALL convictions including SPENT convictions MUST be disclosed. The disclosure of a criminal record or other information will not debar you from participating as a volunteer unless the UCPSA considers that the conviction renders you unsuitable. In making this decision the UCPSA will consider the nature of the offence, how long ago it was committed and what age you were at the time and other factors which may be relevant. This information will be verified through an appropriate Access NI Enhanced Disclosure check. If you have received a formal caution or are currently facing prosecution for a criminal offence you should also bring this to our attention given the “excepted” nature of the role. An arrangement will be made with you to discuss any clarification if required. Thank you for your co-operation.
Have you ever been convicted of a criminal offence, been the subject of a caution, been barred by the Disclosure and Barring Service (formally the Independent Safeguarding Authority) which would prevent you from working with children and/or vulnerable adults or the subject of an investigation alleging that you were the perpetrator of adult or child abuse?
Yes No If so, please state below the nature, date(s) and sentence of the offence(s), date prevented from working in this area or allegations
___________________________________________________________________
___________________________________________________________________ Please provide any other information you feel may be of relevance such as:
the circumstances of the offence/incident
a comment on the sentence received
any relevant developments in your situation since then
whether or not you feel the conviction has relevance to this post.
___________________________________________________________________
___________________________________________________________________ Please continue on a separate page if necessary.
(If you require further information on what information to disclose please contact NIACRO Helpline Tel: 028 90 320157)
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Declaration I understand that I must also complete an AccessNI Disclosure Certificate Application Form and that this check must be carried out before my application for registration/ appointment can be confirmed. This has been explained to me and I am aware that spent convictions may be disclosed. I declare that the information I have given is accurate and I am also aware that NI Sports Forum as the umbrella organisation used by UCPSA carrying out the check will share the information returned with the Child protection Officer of UCPSA. Have you ever been known to any Social Services department as being a risk or potential risk to children?
YES / NO (if Yes, please provide further
information below):
Have you been the subject of any disciplinary investigation and/or sanction by any organisation due to concerns about your behaviour towards children?
YES / NO (if Yes, please provide further information)
Confirmation of Declaration (tick box below)
I agree that the information provided here may be processed in connection with my volunteer role and I understand that any role may be withdrawn or dismissal may result if information is not disclosed by me and subsequently come to the organisation’s attention.
I agree to inform the organisation within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people.
I understand that the information contained on this form and information supplied by third parties may be supplied by the organisation to other persons or organisations in circumstances where this is considered necessary to safeguard other children.
I declare that any answers are complete and correct to the best of my knowledge and I will inform the Club or UCPSA of any future convictions or charges. Signature: _____________________________________ Print Name: _____________________________________ Date: ___________
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Appendix 8
Volunteer reference form
The following person: _______________________________________________ has expressed an interest in working for: A UCPSA affiliated club. If you are happy to complete this reference, any information will be treated with due confidentiality and in accordance with relevant legislation and guidance. Information will only be shared with the person conducting the assessment of the candidate’s suitability for the post, if he/she is offered the position in question. We would appreciate you being extremely candid, open and honest in your evaluation of this person. 1. How long have you know this person? ______________________________
2. In what capacity? _______________________________________________
3. What attributes does this person have that would make them suited to this
work?_____________________________________________________________
_____________________________________________________________
4. Please rate this person on the following – please tick one box for each statement:-
Poor Average Good V Good Excellent
Responsibility
Maturity
Self-motivation
Can motivate others
Energy
Trustworthiness
Reliability
This post involves substantial access to children. As an organisation committed to the welfare and protection of children, The UCPSA is anxious to know if you have any reason at all to be concerned about this applicant being in contact with children and young people.
YES NO
If you have answered YES we will contact you in confidence. Signed: _________________________________ Date: __________
Print Name: _________________________________
Position: _________________________________
Ulster Clay Pigeon Shooting Association Ltd.
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Appendix 9
Code of Conduct for Volunteers/coaches
All coaches should agree to the following requirements within UCPSA code of
conduct:
Keeping up to date with the technical skills, qualifications and
insurance in shooting.
Involving parents/carers wherever possible (e.g. for the responsibility
of their children or vulnerable adult in the changing rooms).
Ensuring that if mixed teams are taken away, they should always be
accompanied by a male and female member of the club/organisation.
(however same gender abuse can also occur.)
Ensuring that at events where shooters stay away from home, adults
should not enter children’s or vulnerable adults rooms or invite
children or vulnerable adults into their rooms (formal room checks
must always be done with 2 or more members of staff)
Being an excellent role model — this includes not smoking or drinking
alcohol in the company of children or vulnerable adults.
Giving enthusiastic and constructive feedback rather than negative
criticism
Ensure they maintain healthy, positive and professional relationships
with all young members. Instructors/volunteers and others in
positions of authority and trust in relation to members aged 16 and 17
years must not engage in sexual relationships with them while that
unequal power relationship exists
Avoid excessive training or competition and not pushing shooters to
compete or train against their will.
Recognise each individuals needs and capacity
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Securing parental/guardian consent in writing to acting in loco
parentis (in place of a parent), if the need arises to give permission
for the administration of emergency first aid and/or other medical
treatment
Awareness of any medicines being taken by participants, or existing
injuries
Maintain attendance registers during training or competitions
Keep a written record of any injury that occurs, along with the
details of any treatment given
Request written parental consent if club officials/coaches are
required to transport young people in their cars.
Note: Although any physical contact requires a level of agreement safety must
NEVER be compromised.
Avoid
The following should be avoided except in emergencies. If cases arise where these
situations are unavoidable they should only occur with the full knowledge and
consent of someone in charge in the organisation or the child’s or vulnerable
adult’s parents/guardian. For example, a child or vulnerable adult sustains an
injury and needs to go to hospital, or a parent fails to arrive to pick a child or
vulnerable adult up at the end of a session:
Never
The following should never be sanctioned. You should never:
Engage in rough, physical or sexually provocative games, including
horseplay
Share a room with a child or vulnerable adult
Allow or engage in any form of inappropriate touching
Allow children to use inappropriate language unchallenged
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Make sexually suggestive comments to a child or vulnerable adult,
even in fun
Reduce a child or vulnerable adul
Allow allegations made by a child or vulnerable adult to go
unchallenged, unrecorded or not acted upon
Do things of a personal nature for a child, vulnerable or disabled
adult that they can do for themselves
Invite or allow children or vulnerable adults to stay with you at your
home unsupervised.
Spend excessive amounts of time alone with children or vulnerable
adults away from others.
Take children or vulnerable adults to your home where they will be
alone with you.
NB It may sometimes by necessary for staff or volunteers to do things of a personal
nature for children or vulnerable adults depending on the particular nature of their
disability. These tasks should only be carried out with the full understanding and
consent of parents/guardians and the pupils involved. There is a need to be
responsive to a person’s reactions. If a person is fully dependent on you, talk with
him/her about what you are doing and give choices where possible. This is
particularly so if you are involved in any dressing or undressing of outer clothing,
or where there is physical contact, lifting or assisting a child or vulnerable adult to
carry out particular activities. Avoid taking on the responsibility for tasks for which
you are not appropriately trained.
Rules & Responsibilities for member’s behaviour while taking part in international
events are dealt with separately in the ‘International Participation Agreement’
which will be issued prior to an international event.
Print Name_________________________________
Signed______________________________________
Date__________________