Home > The Role of Educators in Preventing and Responding to Child Abuse and Neglect > The Role of Educators in Preventing and Responding to Child Abuse and Neglect: Appendix F - Sample Report of Suspected Child Abuse and Neglect

The Role of Educators in Preventing and Responding to Child Abuse and Neglect
User Manual Series (2003)

Author(s):  Office on Child Abuse and Neglect., Caliber Associates. Crosson-Tower

Year Published:  2003

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You are in section: Table of Contents Preface Acknowledgments 1 - Purpose and Overview 2 - Identifying Reasons Why… 3 - Recognizing Child Abuse and… 4 - Reporting Child Abuse and… 5 - Providing Support After the… 6 - Preventing Child Abuse and… Endnotes Appendix A - Glossary of Terms Appendix B - Resource Listings… Appendix C - Child Abuse… Appendix D - Educators Checklist… Appendix E - Sample List of Contacts… Appendix F - Sample Report of Suspected…

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Appendix F
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 (Principal or School Social Worker)                                                                  

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 - Identifying Reasons Why… 3 - Recognizing Child Abuse and… 4 - Reporting Child Abuse and… 5 - Providing Support After the… 6 - Preventing Child Abuse and… Endnotes Appendix A - Glossary of Terms Appendix B - Resource Listings… Appendix C - Child Abuse… Appendix D - Educators Checklist… Appendix E - Sample List of Contacts… Appendix F - Sample Report of Suspected…

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.

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Updated on October 9, 2009