Home > The Role of Professional Child Care Providers in Preventing and Responding to Child Abuse and Neglect > Appendix E: Sample Report of Suspected Child Abuse and Neglect

The Role of Professional Child Care Providers in Preventing and Responding to Child Abuse and Neglect
User Manual Series (2008)

Author(s):  Children's Bureau Karageorge, Kendall

Year Published:  2008

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You are in section: Table of Contents Preface Acknowledgments 1 - Purpose and Overview 2 - Recognizing Child Abuse or Neglect 3 - Reporting Suspected Child Abuse or Neglect 4 - Minimizing the Risk of Maltreatment in Child Care Programs 5 - Preventing and Responding to Child Abuse and Neglect… 6 - Responding to Allegations of Child Maltreatment… 7 - Caring for Maltreated and At-Risk Children 8 - Supporting Parents Endnotes Appendix A - Glossary of Terms Appendix B - Resource Listings of Selected National Organizations Appendix C - State Telephone Numbers… Appendix D - Handouts for Parents Appendix E - Sample Report of Suspected Child Abuse or Neglect Appendix F - Risk Indicators: Touch Policy Appendix G - Risk Indicators: Developmental Expectations… Appendix H - Risk Indicators: Child Abuse Prevention Curriculum Appendix I - Family Support Strategies

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Appendix E: Sample Report of Suspected Child Abuse and Neglect

Call: Local Social Services Agency or Law Enforcement Agency (Phone Numbers)                          

Date of Call(s):_________________________ Name of Person(s) Talked To:____________________

Notified: Designee (Center Director or Nurse)                                                                  

Date of Notification:________________________ Date of This Report:__________________________

Name of Person(s) Responsible for Child's Care: (Parents/Stepparents/Guardians/Custodial Parents)

With Whom Does the Child Live:_____________________ Relationship:_________________________

Person(s) Suspected of Abuse or Neglect: ___________________ Relationship:_________________

Check appropriate space indicating type of suspected abuse being reported:

State the nature and extent of the current injury, neglect, or sexual abuse to the child in question and circumstances leading to the suspicion that the child is a victim of abuse or neglect:

Information concerning previous injury, sexual abuse or neglect experienced by this child or other children in this family situation, including previous action taken, if any:

State other information that may be helpful in establishing the cause of the child' status:

_______________________________________________________________________________________

Distribution: Local Social Services or Law Enforcement Agency/Designee/Other

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You are in section: Table of Contents Preface Acknowledgments 1 - Purpose and Overview 2 - Recognizing Child Abuse or Neglect 3 - Reporting Suspected Child Abuse or Neglect 4 - Minimizing the Risk of Maltreatment in Child Care Programs 5 - Preventing and Responding to Child Abuse and Neglect… 6 - Responding to Allegations of Child Maltreatment… 7 - Caring for Maltreated and At-Risk Children 8 - Supporting Parents Endnotes Appendix A - Glossary of Terms Appendix B - Resource Listings of Selected National Organizations Appendix C - State Telephone Numbers… Appendix D - Handouts for Parents Appendix E - Sample Report of Suspected Child Abuse or Neglect Appendix F - Risk Indicators: Touch Policy Appendix G - Risk Indicators: Developmental Expectations… Appendix H - Risk Indicators: Child Abuse Prevention Curriculum Appendix I - Family Support Strategies

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Updated on October 9, 2009