CHCLEG001 Reasonable Suspicion of Child Abuse and Neglect Assessment Report

CHCLEG001 Reasonable Suspicion of Child Abuse and Neglect Assessment Task

 

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I am a worker of the __________________________________________________________________ and I have become aware, or reasonably suspect, that the following child/ren: _______________________________________________

  1. have/has been harmed; or
  2. are/is at risk of being harmed.

 

1. DETAILS OF CHILD/REN AND FAMILY (complete all that are known)

Child/ren’s names including aliases (write ‘unborn child’ if child is not yet born) Gender Age and/or date of birth (if known) Cultural Identity (if known)

 

Parent/s or carer/s names including aliases Gender Age and/or Date of Birth (if known) Cultural Identity (if known)

 

1. Child/ren’s usual address and contact details (if known):

 

2. Are the child/ren living in more than one household (if known): If yes, what is the other address (including contact details and which child/ren reside there)?

 

3. Details of other relevant person/s and household member/s:

 

4. Current location of children (if known):

 

5. Alleged person/s responsible (if known) and their relationship to the child/ren:

 

6. Current location of alleged person/s responsible (if known):

 

7. School (including grade) or Child Care details (if known):

 

2. ABUSE TYPE BEING REPORTED (more than one may be ticked)

Suspected:       o  Physical abuse        o  Emotional abuse         o  Sexual Abuse             o  Neglect

At risk of:         o  Physical abuse        o  Emotional abuse         o  Sexual Abuse             o  Neglect

 

Source of information: (please circle any that apply, if applicable)

Direct Observation          Deduction           Hearsay from others

 

1. Explain what you saw, heard, were told about the child/ren: (attach additional pages if necessary)

 

2. Outline the impact you believe the events above have had or may have on the child/ren: (attach additional pages if necessary)

 

3. YOUR DETAILS

Name and work telephone number:

 

1. What is your agency’s current involvement with the child/ren or family:

 

2. Please provide a brief summary of the history of your or your agency’s involvement with family and/or child/ren that may be relevant to the Department of Communities – Child Safety Services (eg. Details of any prior domestic violence incidents; criminal history; unexplained injuries).

 

3. Have you or your agency taken any action to protect the child/ren?  If yes please provide details:

 

4. Names and contact details of any other persons or services who can provide additional information:

 

5. Are the parent/s aware of your agency’s referral to Department of Communities – Child Safety Services?

 

6. Would you like the Department of Communities – Child Safety Services to contact you and advise the outcome of this referral?                                                                                                 

 

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