Form

DBS paper referral form guidance

Updated 18 February 2016

This guidance document should only be used to complete the DBS paper referral form. It doesn’t support completion of the online DBS referral form, which has its own onscreen guidance.

The Safeguarding Vulnerable Groups Act 2006 (SVGA) places a legal duty on employers and personnel suppliers to refer any person who has:

• harmed or poses a risk of harm to a child or vulnerable adult
• satisfied the harm test
• received a caution or conviction for a relevant offence

A regulated activity provider is an organisation or individual that is responsible for the management or control of regulated activity, paid or unpaid, and makes arrangements for people to work in that activity.

This will usually be an employer or a voluntary organisation.

Examples of a regulated activity provider would be:

• an NHS hospital or Health and Social Care Trust that employs people to provide care, supervision and advice to children and vulnerable adults
• a Further Education College that provides education to children under 18 years of age
• a specialist educational establishment that provides education to vulnerable adults.

A regulated activity provider can also be a person who manages volunteers in a regulated activity position, such as a scout leader or as part of a charitable organisation.

A personnel supplier is an employment agency or business that makes arrangements with a person to find them employment, or they may supply that person to employers.

A personnel supplier is also an educational institution who arranges for its students to undertake placements as part of their studies.

This guide provides general information for regulated activity providers and personnel suppliers to complete the DBS referral form.

For guidance on the general duty to refer please see our guides.

Personnel suppliers: if you are a personnel supplier under a duty to refer, please follow these instructions to complete the form then read the personnel suppliers guide.

From 10 September 2012 local authorities, keepers of registers and supervisory authorities are not required by law to make referrals to the DBS.

However, the Safeguarding Vulnerable Groups Act 2006 does give them the power to refer if they believe it is appropriate to do so.

Legal requirements
Information in “Legal Requirements” boxes relates only to where regulated activity providers and personnel suppliers have a legal duty to refer. See the referral guides for more information.

These sections represent the information that you are required to provide to the DBS by law under the Safeguarding Vulnerable Groups Act 2006 (Prescribed Information) Regulations 2008. This duty only extends to the information identified if you hold it. You don’t need to get or create additional information.

Documentation
Documentary evidence should be supplied with any referral. You are legally required to provide the documents highlighted under “Legal Requirements” (if they are held by you). “Documentation” boxes are a guide to the type of documents you may wish to consider providing with your referral but are not necessarily legally required. These documents have been demonstrated to assist the DBS in the assessment of cases.

General guidance for completing the DBS referral form

When completing this form, if there is any additional information, please continue on separate sheets.

Part 1: Details of the person you are referring

The information you provide in this section will help us establish the identity of the person you are referring. Without this information we may not be able to gather additional information from the police or, if we bar them, make sure that their barring status shows up on their DBS check.

Legal requirement
The legal requirement to supply information for this section is as follows:

• full name and title
• any other name or names by which they are known or a person may be known
• date of birth
• National Insurance Number
• gender
• last known address (including postcode)

Information as to whether or not a person is included in any relevant register as defined in section 41(7) of the Safeguarding Vulnerable Groups Act 2006 or any register established and maintained by a supervisory authority and, if so, details of the relevant entries in any such register.

Section A - Personal information

Title
The title used by the person you are referring. If different from the options supplied, please specify by what title the person you are referring is known.

Name
Please provide the full name of the person you are referring including any middle names.

Date of birth
Please give the person’s date of birth. If you don’t know their date of birth, please give their age or approximate age.

Previous names and/or alias dates of birth
Please provide details of any other names that the person is, or has been, known by.

For example, any maiden names or aliases the person you are referring is known to use. Also, if you are aware that a person has used an alias date of birth, please also provide this information.

Gender
Please indicate whether the person you are referring is male or female.

Nationality
Please state the nationality of the person you are referring.

National Insurance Number
Please provide the person’s National Insurance Number if known. An employer will always have this information as it is used when paying workers.

Section B - Contact details of the person you are referring

Contact address/Post Code/Country
Please give a full postal address (including postcode and country) of the person you are referring.

Home and mobile numbers
Details of the person’s contact telephone numbers should include the area dial code and where necessary the country code.

Work telephone number
If the person you are referring still works for you in a non-regulated activity role, please provide a work telephone number they may be contacted on.

Email address
If known, please provide details of the home email address for the person you are referring.

Section C - Address history

If you are aware the person you are referring has resided at any other address, please provide a full postal address including postcode and country (where applicable).

Section D - Professional registration

Professional bodies are organisations like the General Medical Council or the Nursing and Midwifery Council. For a full list of professional bodies please see the DBS website.

Section E - Teacher reference

Where the person you are referring is a teacher registered in England or Wales please supply their Teachers Pension Number.

Section F – DBS criminal record checks

If you have a DBS reference number for either a Standard or Enhanced criminal records check, please include the number here.

Part 2: Qualifications and training history of the person you are referring

This section helps us to understand the level of training and skills in relation to their role.

Legal requirement

• a person’s qualifications
• details of any relevant training undertaken by the person

Section G - Qualifications

If the person has had relevant training but you do not hold certificates, please tell us what the training was. Relevant training would include any training that is relevant to the harm, for example if a teacher slapped a child then child protection training would be relevant or if a carer dropped a vulnerable adult then manual handling and safe lifting training would be relevant.

Please state the title of any qualifications and the dates of any certificates.

Documentation
To evidence this area the following documentation should be supplied with the referral:

• copies of professional qualification certificates

Section H – In service training/other courses attended

It is recognised that not all training is accredited. If the person has attended relevant training which is not accredited, for example in-service training, short courses etc. this information should also be supplied.

Please provide us with the details of any training or other course and the dates attended.

Documentation
To evidence this area the following documentation should be supplied with the referral:

• copies of training certificates which are relevant to this referral

Part 3: Details of the work carried out by the person you are referring

The information provided in this section allows us to better understand the nature of the work carried out by the person you are referring and their previous experience. This section also allows us to understand whether the person has worked with children or vulnerable adults. It also allows us to identify any connection to work they may have carried out in Scotland.

Legal requirement

• a description of the regulated activity that the person you are referring is, or was, engaged in
• information (including copies of relevant documents) relating to their employment, such as:
  • the application for employment, and the letter of appointment
  • their job description including the position held and the duties carried out by them
  • the date they started the employment
  • their employment history
  • their disciplinary record

Whether or not they are still employed and if so, their current job description and a description of their duties. If they are no longer employed, the date from which and the circumstances in which they ceased to be so employed.

The reasons why permission was withdrawn for them to engage in the regulated activity in question or, where such permission was not withdrawn (but would or might have been withdrawn had they not otherwise ceased to engage in the activity), the reasons why such permission would have or might have been withdrawn.

Section I – About their role

Role Title
This should be the title of the role held by the person you are referring at the time they engaged in relevant conduct, satisfied a harm test or received a caution or conviction for a relevant offence.

Type of role
Please indicate whether the position they held was paid or unpaid/voluntary.

Date they started working/volunteering in the role
This is the date in which the person started to work within regulated activity in the above role.

Date they ceased working/volunteering in the above role
Withdrawing a person from regulated activity in the context of making a referral does not necessarily mean permanently removing them. Once your investigations have established harm or risk of harm to children or vulnerable adults a decision needs to be made as to the best way of managing this information. There are a number of options:

1. return the individual to work with additional training and/or a warning
2. dismiss the individual
3. return the individual to a non-regulated activity
4. continue suspension due to risk of harm while seeking advice

If the decision is to remove the person either through any of points 2 to 4 above, then permission to engage in regulated activity has been withdrawn.

How did they leave or how were removed from the role?
Please indicate the manner/method in which the person you are referring was removed from regulated activity (i.e. dismissed, resigned, retired, or other). If the method of removal is other, please state the method of removal in the space provided.

Was the role held by the person you are referring, ‘regulated activity’ with children, vulnerable adults or both?
The DBS only has the power to bar if the referred person is or has been, or might in the future engage in regulated activity relating to children and/or vulnerable adults.

Please use this area to indicate if the person you are referring was working with children, vulnerable adults, or both in their role.

Is the person still employed by you?
The duty to refer is only applicable if the person you are referring has been removed from working within regulated activity. A person may be removed from working in regulated activity but still be employed by you in another function. Where this is the case we need to understand what role they have been moved to.

To your knowledge, has the person ever worked in Scotland?
If you are aware that the person has worked or carried out voluntary work in Scotland during their career (whether in relation to the role you are referring them for or another role), please state Yes. If you are unsure or do not know, please state No.

Documentation
To satisfy the legal duty to refer, please ensure that you include the following documentation when submitting the referral form:

• the application for employment made by the person you are referring
• the letter of appointment sent to them
• job description/role statement/person specification
• interview report
• references
• where you have moved the person to another role, the job description/role statement/person specification

Section L – Previous / Other employment (including volunteer work if known)

The career history of a person can greatly assist the DBS to understand the level of experience a person has had working with vulnerable groups (including children) and allow us to identify other parties who may hold relevant information and to identify whether the person is, has or might in the future work in regulated activity with children or vulnerable adults.

Documentation
To help satisfy the legal duty to refer you may wish to consider providing the following documents:

• curriculum vitae (CV)
• previous contracts of employment

Part 4: Reason for the referral

The information you give us in this section will help us make an analysis of the harm caused. This will allow us to see if the person has carried out “Relevant Conduct” or if they pose a “Risk of Harm”. This is how we decide which of the DBS’ powers we need to use in considering the case. Please give us as much factual information as possible.

Legal requirement
Regulated activity providers and personnel suppliers are required by law to refer a person where they have:

• harmed a child or vulnerable adult (engaged in relevant conduct)
• pose a risk of harm to vulnerable groups including children (satisfied the harm test)
• received a caution or conviction for a relevant offence

You are required to provide information relating to the person’s conduct, (including copies of relevant documents), namely:

• a summary of the conduct including details of the setting and location in which such conduct occurred
• details of any harm suffered by any child or vulnerable adult resulting from or arising from the conduct or any risk of harm that a child or vulnerable adult was, or may have been, exposed to as a result of such conduct
• whether the person you are referring has accepted responsibility for or admitted the conduct or any part of it
• any explanation offered by the person you are referring for the conduct or any remorse or insight demonstrated by them in relation to the conduct
• any information other than that relating to the person’s conduct which is likely to, or may, be relevant in considering whether they should be included in or removed from a barred list including information relating to any previous offences, allegations, incidents, behaviour or other acts or omissions

It is a legal requirement to supply information relating to the reason why you consider that the harm test is satisfied in relation to the person you are referring.

You are also required to provide details of any investigation undertaken by any person in relation to the person’s conduct including:

• the evidence and information obtained and considered in any such investigation
• the outcome of the investigation, if known
• the contact details (including a name, address, telephone number and e-mail address) of any person responsible for the investigation

Another legal requirement is for you to provide details of any other proceedings before any court, tribunal or any other person taken or to be taken in relation to the conduct of the person you are referring including the outcome of any such proceedings. This also includes proceedings brought under the Children Act 1989.

Details of any action taken, or to be taken, by you (the person referring or providing information under the Safeguarding Vulnerable Groups Act 2006), to the DBS in relation to the person’s conduct including whether or not the matter has been referred to the police or to any other person.

Section M – Purpose of the referral

Please indicate under which legal basis you are referring the person – only one should be selected.

• harmed a child or vulnerable adult through their actions or inaction (relevant conduct)

Harm should be considered in a wider context than just physical and can take numerous forms.

Types of harm relating to children can include (but are not limited to):

• emotional/psychological - action or inaction by others that causes mental anguish
• physical - any intentional physical contact that results in discomfort, pain or injury
• sexual - any form of sexual activity with a child under the age of consent
• neglect - failure to identify and/or meet care needs

Types of harm relating to adults can include (but are not limited to):

• emotional/psychological - action or inaction by others that causes mental anguish
• financial - usually associated with the misuse of money, valuables or property
• physical - any intentional physical contact that results in discomfort, pain or injury
• sexual - coercion or force to take part in sexual acts
• neglect - failure to identify and / or meet care needs

• verbal - any remark or comment by others that causes distress

• represent a risk of harm to a child or vulnerable adult (satisfied the harm test)

To satisfy the harm test there needs to be credible evidence of a risk of harm to vulnerable groups including children such as statements made by an individual regarding conduct/behaviour, etc. For a case to be considered as a risk of harm, relevant conduct would not have occurred but there must be tangible evidence rather than a “feeling” that a person represents a risk to children and/or vulnerable adults.

• have received a caution or conviction for a relevant offence

A relevant offence for the purposes of referrals to DBS is an automatic inclusion offence as set out in the Safeguarding Vulnerable Groups Act 2006 (Prescribed Criteria and Miscellaneous Provisions) Regulations 2009 and the Safeguarding Vulnerable Groups (Prescribed Criteria and Miscellaneous Provisions) Regulations (Northern Ireland) 2009.

A list of relevant offences is detailed in our referral guides.

Section N – Summary of the circumstances which has resulted in this person being removed from regulated activity

In order to consider whether a person should be barred from working with vulnerable groups including children, we need to know how the person:

• harmed a child or vulnerable adult
• put them at risk
• how you believe they represent a risk
• as a consequence of the above, what made you remove the person from working with children or vulnerable adults

Please give a brief summary of the incident that led to this referral. If there are multiple incidents, then please continue on separate sheets if required.

Has the person you are referring admitted or accepted responsibility for any harm?
If the person you are referring has admitted any responsibility for the events which have occurred (i.e. apologised, admitted fault in statements, etc.) please indicate “Yes”. If the person has not admitted any responsibility, please indicate “No”. If you are unsure or do not know please indicate “Don’t know”.

Documentation
To help satisfy the legal requirement the types of documents you may wish to consider supplying are as follows:

• witness statements
• statement from the person you are referring
• details of internal investigations and outcome (including investigator’s contact details)
• details of internal disciplinary action and outcome
• police investigations and reports
• local authority investigations and reports (including relevant Adult Social Strategy Meetings)
• investigations and reports of professional regulators / registration bodies
• investigations and reports of any other agencies or bodies
• court or tribunal proceedings and outcomes including proceedings brought under the Children Act 1989

Section O – Other organisations or agencies involved in the circumstances of the referral

As the DBS has no investigatory powers it is important for us to understand which organisation may have been involved and who may hold information on a case.

This information may be used by the DBS to gather additional evidence in relation to the referral.

Organisation / address
The name and address of any organisations involved other than the referring party (for example local authorities, the police, etc.)

Contact person / role
Please provide the name of any relevant contact(s) or role(s) working for the organisation that have been involved.

Contact number / email
The details of any contact numbers or emails for the above organisation(s) / contact(s) / role(s).

Part 5: Chronology of events

This section will allow us to understand in what order events have taken place which have lead to the person you are referring being removed from regulated activity.

Legal requirement
You are required to provide information relating to the person’s conduct, (including copies of relevant documents), namely:

• a summary of the conduct including details of the setting and location in which such conduct occurred
• details of any harm suffered by any child or vulnerable adult resulting from or arising from the conduct or any risk of harm that a child or adult was, or may have been, exposed to as a result of such conduct

Section P – Chronology of events relating to this referral

This may be continued on separate sheets if required.

Date
Please indicate the days on which key events took place. This information should be recorded in chronological order.

Event
A brief description of what happened on the dates identified.

Relevant documents
Please identify any document you are supplying that relates to an event, for example witness statements related to events on specific dates or minutes of strategy meetings.

Persons involved
Please identify any key persons involved in events, such as witnesses, victims, etc.

Part 6: Details of the child or adult harmed / put at risk of harm

Where possible please tell us the full name of the person who was harmed. Without this, any information that you give us potentially carries less weight and the DBS may not be able to rely on the information to apply a barring decision.

Legal requirement
Details of any child or adult harmed including:

• the name and date of birth of the child or vulnerable adult
• details of the relationship between the person you are referring and the child or vulnerable adult harmed
• information relating to the vulnerability of the child or vulnerable adult that may be relevant to the DBS’ consideration of whether to include or remove the person you are referring from a barred list including any emotional, behavioural, medical or physical condition

Section Q - Details of the person harmed / put at risk of harm

Title
The title used by the person harmed. If different from the options supplied please specify by what title the person you are referring is known.

Name
Please provide the full name of the person harmed including any middle names.

Date of birth
Please give the person’s date of birth. If you don’t know their date of birth please give their age.

Gender
Please indicate whether the person harmed / put at risk of harm is male or female. If there are multiple victims, please provide their details on additional sheets.

Documentation
To assist in the duty to refer, you may wish to consider providing the following information:

• extra sheets telling us about other children or vulnerable adults who were harmed (see harmed person template).
• harmed individual(s) care plan
• victim impact report or statement(s) (include details of who made the assessment and their position or qualifications to make the assessment)

Section R – Relationship between the referred individual and the person harmed / put at risk of harm

Please explain the relationship between the referred individual and the harmed person(s) e.g. if the referred person was a member of staff did they have specific responsibilities for the harmed person such as a key worker. If there were no specific duties how did the referred individual know the harmed person?

Details of any vulnerability, e.g. emotional, behavioural, medical or physical
Please provide a description of any specific vulnerabilities relating to the person harmed, for example if a service user, what service the person was receiving which made them vulnerable.

To gain a better picture of the person harmed details of any other relevant illnesses, impairment or disabilities (e.g. learning / physical difficulties, etc) are also useful to gain a better understanding of the type and nature of care needed by the individual.

Part 7: Documentation supplied

All referrals should be supported by documentary evidence. The nature and type of documentation will vary on a case by case basis and will depend on individual specific circumstances of a case and the nature of any investigations carried out. Providing documentation relating to a referral allows the DBS to gain a much greater understanding of events and come to a more informed decision.

In addition there are a number of documents which you are legally required to provide to the DBS.

Legal requirement
Regulated activity providers and personnel suppliers are required by law to refer a person where they have:

• harmed a child or vulnerable adult (engaged in relevant conduct)
• represent a risk of harm to vulnerable groups including children (satisfied the harm test)
• received a caution or conviction for a relevant offence

You are required to provide information relating to the person’s conduct, (including copies of relevant documents), namely:

• a summary of the conduct including details of the setting and location in which such conduct occurred
• details of any harm suffered by any child or vulnerable adult resulting from, or arising from the conduct or any risk of harm that a child or vulnerable adult was, or may have been, exposed to as a result of such conduct
• whether the person you are referring has accepted responsibility for or admitted the conduct or any part of it
• any explanation offered by the person you are referring for the conduct or any remorse or insight demonstrated by them in relation to the conduct
• any information other than that relating to the person’s conduct which is likely to, or may, be relevant in considering whether they should be included in or removed from a barred list including information relating to any previous offences, allegations, incidents, behaviour or other acts or omissions

You are also required to provide details of any investigation undertaken by any person in relation to the conduct of the person you are referring, including:

• the evidence and information obtained and considered in any such investigation
• the outcome of the investigation, if known
• the contact details (including a name, address, telephone number and e-mail address) of any person responsible for the investigation

If any disciplinary proceedings or measures have taken place, or to be taken, in relation to the person’s conduct you are required to provide details including:

• the evidence and information obtained and considered in such proceedings or with respect to such measures
• the outcome of any disciplinary proceedings or measures taken including a copy of any decision or other document evidencing the outcome of such action

If this matter is to be / has been considered in legal proceedings, details of any other proceedings before any court, tribunal or any other person taken or to be taken in relation to the person’s conduct including the outcome of any such proceedings (including proceedings under the Children Act 1989).

You are also required to provide details of any action taken, or to be taken, by the referring party under the Safeguarding Vulnerable Groups Act 2006 to the DBS in relation to the person’s conduct including whether or not the matter has been referred to the police or to any other person.

Section S – Supplied documents

Please indicate the documents which you are including with this referral from the list provided.

Section T – Additional documents supplied

Where you are providing additional documents not listed in Section S, please state the name of the document in this section.

Part 8: Referring party

We cannot provide information to any person who is not detailed on the referral form unless a change of person is notified to us in writing.

Section U – Referring organisation / establishment

Name of organisation
Please state the full name of the business/ organisation/charity that is making the referral.

Type of organisation
Please provide a brief description of the type of organisation (e.g. care home, state school, independent school, etc.)

Sector
Please use the dropdown list to identify the referring organisations sector of work. If the sector of work is not highlighted please select “Other”.

Contact address
This should be the full address at which the DBS may contact the referring organisation.

Section V – Primary contact and alternative contact

It is important the DBS are able to contact the referring organisation. This will allow the DBS to follow up on your referral, and where a legitimate interest exists inform you of the outcome. The name and contact details of a responsible person must be included here.

For both primary and alternative contact please provide their:

• name
• position
• telephone number
• mobile number
• email address

Part 9: Declaration – information sharing / complete and accurate information

The referring party is required to sign the declaration on the referral form confirming their understanding that:

• any information they have supplied within the referral form or additional to it will be used by the DBS for official purposes and may be retained under its Data Retention Policy
• any information they have supplied within the form or additional to it may be disclosed to the referred person or to other parties such as police, professional regulators, prison or probation services in accordance with statutory powers or duties under the Safeguarding Vulnerable Groups Act 2006 or other applicable legislation
• by completing the declaration, the referring party is confirming that to the best of their knowledge the information in the form is complete and accurate and that all documents legally required and any other relevant documentation held by the referring party are provided
• DBS may contact the referring party about the information it holds on the person they have referred

Section W – To be signed by the person making the referral

The person making the referral should be authorised to do so and able to sign the declaration on behalf of the organisation.

To complete this section the person making the referral (on behalf of the organisation) must complete:

Signature
This is the signature of the person making the referral.

Name
This is the name of the person making the referral. Please enter the name in BLOCK CAPITAL letters.

Date of the referral

Position
Position of the person making the referral (e.g. job role/title)

Organisation
Name of the organisation making the referral.

Relationship to the individual you are referring
Please state the relationship between the person making the referral and the person being referred (e.g. Line Manager, Departmental Manager, etc).

Section X – Returning the form

When submitting the completed referral form and associated documentation please make sure you have checked that you have answered all the questions you are able to, and signed the declaration.

The referral form and all relevant documents should be returned to the address shown on the form.

If you have any problems completing the referral form or any queries, please call the DBS referral helpline on 03000 200 190.

Additional Information
You may wish to provide additional information to support a referral.

Additional information can be given on separate sheets. Alternatively you can use the DBS additional information form.