Dd Form 2952 - Closeout Report Of Suspected Child Abuse In Dod Operated Or Sponsored Activities

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REPORT CONTROL SYMBOL
CLOSEOUT REPORT OF SUSPECTED CHILD SEXUAL ABUSE
DD-P&R(Q)2052
IN DOD OPERATED OR SPONSORED ACTIVITIES
SECTION A - ADMINISTRATIVE INFORMATION
1. NAME OF INSTALLATION
2. STATE/COUNTRY
3. POINT OF CONTACT
a. NAME (Last, First, Middle Initial)
b. POSITION
c. CONTACT INFORMATION
(1) DSN TELEPHONE NUMBER
(2) COMMERCIAL TELEPHONE NUMBER
(3) FAX NUMBERS (DSN and Commercial)
(Include Area Code)
(4) E-MAIL ADDRESS
4. ACTIVITY WHERE SUSPECTED ABUSE OCCURRED
5. DATE OF INITIAL REPORT TO DUSD(P&R)
(MM/DD/YYYY)
7. PUBLICITY (X all that apply)
b. REPORTED IN CIVILIAN MEDIA
a. INSTALLATION "TOWN MEETING"
PRINT
BROADCAST
(1) LOCAL:
c. MILITARY PUBLIC AFFAIRS:
AUTHORIZED PUBLICATIONS
AFN
(2) NATIONAL:
PRINT
BROADCAST
SECTION B - VICTIM INFORMATION
7. INITIAL POTENTIAL VICTIM POOL (Enter numbers)
8. TOTAL POTENTIAL VICTIMS SCREENED AND
NEEDING FORENSIC INTERVIEWS: (Enter numbers)
a. POTENTIAL VICTIMS NOT CONTACTED:
a. POSSIBLE VICTIMS NOT INTERVIEWED:
b. POTENTIAL VICTIMS WHO DECLINED
SCREENING:
b. POSSIBLE VICTIMS INTERVIEWED:
c. POTENTIAL VICTIMS SCREENED:
9. TOTAL PROBABLE VICTIMS (Enter numbers)
a. SEX OF PROBABLE VICTIMS:
MALE
FEMALE
b. AGE RANGE OF PROBABLE VICTIMS:
FROM
TO
10. SPONSORS OF PROBABLE VICTIMS (Enter numbers)
ARMY
NAVY
MARINE CORPS
AIR FORCE
DEFENSE AGENCY
UNAFFILIATED
DD FORM 2952, JUN 2012
Adobe Professional 8.0

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