Risk of Harm Report
Reporter's Details
Full Name:
Ministry Role:
Contact Details:
Child/vulnerable person's details
Name:
Age:
Date of Birth:
Contact Details:
Other information: eg school, language spoken, physical description of person
Parent/caregiver deatils:
Caregiver Details:
Age:
Other information: language spoken, physical description of person
Concerns for the child/vulnerable person
Record a full account of the concerns for the safety, well-being or welfare of the child or vulnerable person. Include as much detail as possible as well as relevant dates and times. Include anything observed: indicators/ behavioural changes / safety concerns / verbal comments or conversations
*
Signature:
Signature:
Date:
Submit