Child Abuse Report

CHILD ABUSE REPORT FORM
If you believe a child is at immediate risk of abuse - phone 000

* Indicates required field

1. DATE OF INCIDENT (dd/mm/yyyy) *

TIME OF INCIDENT *

2. LOCATION of INCIDENT: *

NAME OF PERSON LODGING REPORT (you) *

3. NAME(s) OF CHILD / CHILDREN INVOLVED *

NAME(s) OF PERSON(s) SUSPECTED: *

4. PLEASE CATEGORISE THE INCIDENT: *

5. PLEASE DESCRIBE THE INCIDENT (what you observed, heard or have been made aware of). *

How did you become aware of this information? Is there any other information you feel to include? *

7. WITNESSES (Did anyone else directly witness the incident?) *

Name and phone number of witness(s) (if applicable) *

8. DATE OF REPORT (today) (dd/mm/yyyy) *

Thankyou for taking the time to complete this report. It will be forwarded to ALC admin once submitted.

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