The Suspected Child Abuse Form printable pdf download

The Suspected Child Abuse Form

The “Suspected Child Abuse and Neglect” Form

Please fill this form out immediately if you suspect a child is a victim of abuse, neglect or

exploitation. Please include as many details as possible. Please contact your state abuse

registry and the nearest Director of First Priority. If you do not now your state’s child

abuse hotline, get on

to find it. If you do not know who your local First

Priority leadership is, fill out this form and contact First Priority through the

website.

Today’s Date ______Your Name_______________________ cell # _____________

Name of child __________ Child’s phone number _______________

How do you know the student?

How were you made aware of the child’s suspected abuse?

Where were you when this conversation occurred?

Who else was present?

What is their contact information?

Have you contacted First Priority? If yes, with whom did you speak?

Have you contacted the State Abuse Registry?

If yes, with whom did you speak?

What do know about the suspected abuse/what did the student tell you?

The Suspected Child Abuse Form