Ongoing suitability of staff - Half Yearly Staff Declaration

Name:  
Setting: The WillowsReffleyTwinkle TotsNCC 
Version: 3.0

Please answer the questions and sign the declaration below to demonstrate that you are safe to work with children. If there are any aspects of the declaration that you are not able to meet, you should disclose this immediately to the manager/senior who you report to. 

1. Have you been cautioned, subject to a court order, bound over, received a reprimand or warning or found guilty of committing any offence since the date of your most recent enhanced DBS disclosure?
   
    Yes
    No
2. Have you been cautioned, subject to a court order, bound over, received a reprimand or warning or found guilty of committing any offence either before or during your employment at this setting?
   
    Yes
    No
3. Have you been convicted of an offence against a child (for example murder, kidnapping, rape, indecent assault, assault causing actual bodily harm, neglect or other child-related issues etc)?
   
    Yes
    No
4. Are you included on the barred list of persons considered unsuitable to work with children, which is held by the Disqualification and Barring Service (DBS)?
   
    Yes
    No
5. Have you been made the subject of an order where a child has been removed from your care or prevented from living with you?
   
    Yes
    No
6. Have any of your own children been subject to a child protection plan whilst in your care?
   
    Yes
    No
7. Have you been questioned by the police or social services in relation to yourself, a family member, a romantic partner or your care of your own children?
   
    Yes
    No
8. Do you struggle to lift, carry and move around children or resources or have any other physical difficulties that may affect you caring for children?
   
    Yes
    No
9. Are you suffering from any ongoing medical conditions or mental health issues, or are there any current investigations underway in relation to your health that could affect your ability to care for children?
   
    Yes
    No
10. Are you taking any medication on a regular basis or any other substances (alcohol/drugs) that could affect your ability to care for children or that your manager needs to know about?
    
     Yes
     No
11. Has anyone in your household or someone thought to be reasonably connected to you (boyfriend for example) been the subject historically or is currently under-investigated or has been subject to social services, police or court orders in regards to safeguarding children?
    
     Yes
     No

If you have answered yes to any of the questions, please provide further information below, including, where possible, the names of any professionals who may need to be contacted (hospital consultant, GP, social worker etc)

Please provide information about any volunteering or other work (either paid or unpaid) that you currently undertake (include the role, name of employer/ organisation, and address) 

All staff should now sign the declaration below:

• I understand that if I fail to provide true and accurate information on this form, and fail to disclose all relevant details regarding my suitability to care for children, my employer may have the right to terminate my employment, subject to my contract of employment. Providing false or misleading information may be considered gross misconduct.

• I acknowledge my responsibility to safeguard children and understand that I must inform my manager as soon as possible of any matters that may affect my suitability to do so (for example, concerns regarding my ability to protect my own children, being interviewed by a social worker regarding personal matters, or any investigations related to paid, voluntary, or unpaid work).

• I will ensure that I notify my employer of any convictions, cautions, court orders, reprimands, warnings, or formal interviews with the police that I may receive.

• I will inform my employer of any concerns raised by Social Services, meetings, or investigations by similar services, regarding myself or individuals in my household.

• I understand that if I am taking medication on a regular basis which may affect my suitability, I must notify my employer. I will ensure that any medication is securely stored while at work and kept out of reach of children.

• I will notify my manager if I experience any health concerns that may impact my ability to work with children.

• I give permission for my employer to contact any previous settings where I have worked, local authority staff, the police, the DBS, Ofsted, the LADO, or any medical professionals, to share information about my suitability to care for children, in line with established information sharing protocols.

• I also give permission for my employer to check my Yearly DBS Service Number at any time.