Report of suspected child in need of protection form

Privacy Notice

The Department of Communities, Child Safety and Disability Services is collecting your personal information for the purpose of recording your details as a person providing a notification of, or information given about, a child suspected of being in need of protection in order for the department to undertake its responsibilities under the Child Protection Act 1999.

This information is collected under the Child Protection Act 1999. Your personal information and the other information you provide will be kept confidential in accordance with the provisions of that Act, and only used or disclosed as that Act may permit.

Your information will also be handled in accordance with the Information Privacy Act 2009.


Report

If the child/ren is in immediate danger or in a life-threatening situation contact Emergency Services immediately by dialling 000.

If you are making this report outside of business hours (Monday to Friday 9am-5pm) and you consider an immediate response by Child Safety is required, you should contact the Child Safety After Hours Service Centre (CSAHSC) on 1800-177-135 or 07 3235 9999, or, if you are a mandatory reporter you can use the direct line below:

Intake Service
Child Safety After Hours Service Centre
Direct Line
1300 681 513
3235 9901
Fax
07 3235 9898

Reporter’s details
Alternate contact person details
Subject child/young person details



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Parents/caregiver/other relevant persons (eg. other children in household)



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Household details

Provide details of the household of concern including which children and parents/caregivers/other relevant persons reside in this household.

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Suspected child in need of protection concerns

(tick as many as apply)
Examples of physical abuse include hitting, shaking, throwing, burning, biting, poisoning, drowning, using a weapon to inflict punishment.
Examples of neglect include providing unhygienic or unsafe housing, failing to seek medical treatment when required, insufficient supervision, providing insufficient food, clothing or bedding. It can also include failing to act protectively in response to another person’s actions (e.g. allowing a convicted child sex offender to have unsupervised contact with the child).
Sexual abuse can be physical, verbal or emotional in nature. It can include non-contact and contact activities. Examples include kissing, holding or otherwise touching a child in a sexual manner, exposing a sexual body part to a child, having sexual relations with a child under 16 years of age, using sexually explicit language which is not age or developmentally appropriate when communicating with a child, penetration of the vagina or anus by penis, finger or any other object, oral sex, rape, incest, having a child pose or perform in a sexual manner, forcing a child to watch a sexual act or pornographic material or child prostitution. Sexual abuse may also be suspected based on a child displaying sexualised behaviour which is considered outside the range of age-appropriate sexualised behaviours.
Examples of emotional/psychological abuse include rejection, hostility, and teasing/bullying, yelling criticism, exposure to domestic and family violence.

In this section we want as many details as possible around the circumstances that lead you to reasonably believe that a subject child has experienced or is at risk of experiencing significant harm.

Significant harm can be physical, emotional and/or psychological. Examples of significant harm include internal injuries, burns, fractures, death, learning and developmental delays, neurological changes in a developing brain, fear, anxiety, depression, suicidal ideations, hyper vigilance, and disorganised attachment. Significant harm can also be in consequence of a pattern of harmful events and experiences that may have occurred in the past or are ongoing. When this occurs it is considered to be cumulative harm.

This section aims to identify any presenting behaviours or appearance concerns which may be linked to abuse. Examples include: showing wariness and distrust, rocking, sucking or biting, bedwetting or soiling, demanding or aggressive behaviour, sleeping difficulties, withdrawing from normal activities, self-harming, suicidal thoughts and attempts, having unexplained bruising, being vague about an injury, being overly obedient, being reluctant or fearful to go home, creating stories, poems or artwork about abuse, begging, stealing, hoarding, having matted hair, dirty skin, strong body odour, frequent illness, infections or sores and presenting as underweight or malnourished.

In this section provide as much detail as known around any injury for example location, size, colour, if child is experiencing pain. If known, also provide details regarding any explanations given in regards to the injury

Include details in regards to who sought this medical treatment for the child and details of the doctor/hospital/QAS that provided the medical treatment, if known.

For example domestic violence, alcohol/substance misuse, disability, mental health instability, physical/intellectual disability.

This can include family, friends, church, non-government organisations, government organisations who are providing a service and/or supporting the family and/or children.

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Attachments

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