Freedom to Speak Up

Raise a concern to the LLR LMC Freedom to Speak Up Guardians

If you wish to contact a LLR LMC Freedom to Speak Up Guardian to raise a concern, please complete the form.

We recognise that some people may wish to raise a concern, but would feel more comfortable on being able do it anonymously, which that form gives you the opportunity to do so.

It is important to note, if you report a concern anonymously we will have no mechanism of feeding back and updating you on your concern. However, please be assured all concerns are taken seriously and escalated appropriately.

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* 1. Date of Event

Please input date of event

Date

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* 2. Summary of Concern - please do not include any identifying information

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* 3. Was this raised with your line manager or Partners?

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* 4. If the concern was raised with your line manager, what was the outcome?

No perceived change

No feedback

Not listened to

Other

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* 5. If it was not raised with your line manager/Partner, what was the reason why?

I felt I couldnt

Not considered

Not safe

Other (please specify)

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* 6. Theme of concern

Patient Safety/Quality

Worker Safety/wellbeing

Bullying and Harassment

Inappropriate attitudes and behaviors

Signposting only

Policies/Processes

Other (please specify)

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* 7. Would you like to be contacted by an LMC FTSU Guardian?

Yes

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* 8. If answered yes, do you have a preferred Guardian?

Dr Fahreen Dhanji

Charlotte Woods

No preference

Freedom to Speak Up

Raise a concern to the LLR LMC Freedom to Speak Up Guardians

Question Title

* 1. Date of Event

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* 2. Summary of Concern - please do not include any identifying information

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* 3. Was this raised with your line manager or Partners?

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* 4. If the concern was raised with your line manager, what was the outcome?

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* 5. If it was not raised with your line manager/Partner, what was the reason why?

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* 6. Theme of concern

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* 7. Would you like to be contacted by an LMC FTSU Guardian?

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* 8. If answered yes, do you have a preferred Guardian?

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* 9. Please leave any name and contact details you would like us to contact you on.

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