Child Abuse Reporting Form printable pdf download

Child Abuse Reporting Form

Jackson County School District #6

Child Abuse Report Form

Instructions:

Oregon Law requires that all employees report suspected child abuse to a law enforcement agency or the

Department of Human Services. School employees who suspect child abuse must adhere to the following

reporting procedures:

1. Notify your supervisor

2. Report the suspected abuse to law enforcement or the Department of Human Services

3. Complete the information below:

Student Name____________________________ School _________________________

Employee’s Name________________________ Position________________________

Brief description of incident to be reported:

_______________________________________________________________________

___

_______________________________________________________________________

Agency __________________ Agency employee who received report_______________

Date of report____________________ Building Supervisor________________________

Additional Comments:

_______________________________________________________________________

____

________________________ ______ __________________________

___________

Child Abuse Reporting Form