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Prevent Referral: Referring an individual you believe may be vulnerable to radicalisation

This form is designed for members of the public to refer a safeguarding concern under Prevent – where you are worried that an individual is at risk from Radicalisation. Complete as much of the form as you are able; doing so will help assess the level of risk and identify the correct response required.

If you are referring a concern in a professional capacity working in a Local authority, School, Health sector, Prison, Probation or other organisation with a Prevent referral policy please submit a referral via your recognised Prevent referral process.

If you feel the risk is high and time is critical, you may wish to contact Humberside Police via 999.


Your contact details

Details provided may be used to contact you should further information be required

To report possible terrorist activity anonymously please refer to the Counter Terrorism Policing website.

Details of the individual believed to be at risk

Complete where able and appropriate


Your concerns

Consideration should be given but not limited to; use of inflammatory language, legitimising use of violence, use of symbolism, expression of extremist views, becoming socially isolated, ‘them & us’ language, being influenced by a group, need for identity, meaning & belonging, period of transition, trauma, feeling of grievance etc.

Sharing concerns


Any other Information

Consideration should be given but not limited to; fixation on a topic, learning issues, change in appearance, mental health, concerning internet usage etc.