Child Protection – Disclosure of Harm
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Child Protection – Disclosure of Harm
A disclosure of harm occurs when someone, including a child, tells you about harm that has happened, is happening, or is likely to happen to a child. Disclosures of harm may start with:
- I think I saw…
- Somebody told me that…
- Just think you should know…
- I‘m not sure what I want you to do, but…
Child’s name __________________________________________________________________
What is the name of the person who made the disclosure? _________________________________
Are they related to the child? Yes No |
If yes, what is the relationship? ________________________________________________________
What did the person disclose? Try to use the exact words they used. Use “I said” “they said” statements, include any questions you asked and comments you made
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________
What date did the person make the disclosure? ________________ What time?_______AM/PM
Where did the disclosure occur? _______________________________________________________
Was anyone else present during the disclosure? Yes No |
If yes what is/are their name, role and employer? |
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have you followed the procedure in the Child Protection Policy for making a report? Yes No |
Nominated Supervisor advised? Yes No |
Nominated Supervisor comments if any
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Report made to Police? Yes No |
Only applies if child in immediate danger
or criminal offence
If yes record date, time, reference and advice
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Report made to Child Protection? Yes No |
If yes record date, time, reference and advice or attach acknowledgement from child protection.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Referred to Support Services with family’s consent? Yes No |
If yes record date, time, reference and advice
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Report made to Regulatory Authority? Yes No |
Any physical or sexual abuse that occurred at the
service must be reported
If yes attach acknowledgement
Report made to other relevant organisations? YesNo |
See Child Protection Policy
If yes record date, time, reference and advice
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Describe any other actions you have taken
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
___________________________ | ___________________________ | _____________/_____________ |
Staff Member Signature | Staff Member Name (Please print) |
Date/Time |
___________________________ | ___________________________ | _____________/_____________ |
Witness Signature (if any) | Witness Name (if any) (Please print) |
Date/Time |
___________________________ | ___________________________ | _____________/_____________ |
Nominated Supervisor | Nominated Supervisor (Please print) |
Date/Time |
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