appendix 1 incident record form clay pigeon shooting association ltd. child & vulnerable adult...

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



Governing Body



Local council



(Other e.g. NSPCC)



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

http://www.nspcc.org.uk/northernireland

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

https://maps.google.co.uk/maps/place?cid=14733406273477247248

http://maps.google.co.uk/local_url?dq=&q=http://www.sportni.net/&oi=miw&sa=X&ct=miw_link&cd=1&cad=homepage,cid:14733406273477247248&ei=GXyhUpT2HM7S8QObhIGYAw&s=ANYYN7mfznU5hVoKXteRFJiBmIkBPuXQDg



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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).

http://www.nidirect.gov.uk/accessni




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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

mailto:[email protected]



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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: _________________________________



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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__________________

appendix 1 incident record form clay pigeon shooting association ltd. child & vulnerable adult...

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