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Report of Suspected Child Abuse - Happyville Community Centre Child's name: Justin Marks Date of birth: 01/04/20XX (Age 4) Address: 23 The Avenue, HAPPYVILLE, VIC,
Report of Suspected Child Abuse - Happyville Community Centre | |
Child's name: | Justin Marks |
Date of birth: | 01/04/20XX (Age 4) |
Address: | 23 The Avenue, HAPPYVILLE, VIC, 3222 |
Reasons for concern: | |
What are the family circumstances? | |
Record of staff member observations: | |
Record of conversation of disclosure: | |
Assessment of risk of harm to the child now | |
Current location | At the centre - due to be picked up at 4 p.m. this afternoon when the program ends. |
Information of any known history of abuse | |
Other relevant information (if applicable) | |
Name of the person recording information | |
Signature: | |
Date: | (Make an estimate of when this information should be recorded - date of Justin's disclosure and report to supervisor Ian was the morning of 3rd April 20XX.) |
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