Staff DBS Disclaimer

Staff DBS Disclaimer

This form is to be completed by all staff when they commence employment (including regular volunteers and students). And completed by all staff on a annual basis irrespective of how long they have been in employment.

Please answer the questions and sign the declaration below to demonstrate that you are safe to work with adults within the setting. If there are any aspects of the declaration that you are not able to meet, you should disclose this immediately to the manager/senior responsible for your recruitment.

Have you or anyone living in your household been cautioned, subject to court order, bound order, received a reprimand or warning or found guilty of committing any offence since the date of your most recent enhanced DBS disclosure?
Have you or anyone living in your household been cautioned, subject to court order, bound order, received a reprimand or warning or found guilty of committing any offence either before or during employment at this setting?
Have you or anyone living in your household committed any offences against a adult?
Have you or anyone living in your household committed any offences against an adult (e.g. rape, murder, indecent assault, actual body harm etc)?
Have you or anyone living in your household been barred from working with adults with a learning disability (DBS)?
Are you living with someone who has been barred from working with adults (DBS)?
Has your name or anyone living in your household’s name been placed on the DBS barring list?
Have you or anyone living in your household had any convictions or cautions for the supply of illegal drugs?