My Reporting Procedures

Program Tool

WWW.VIRTUALLABSCHOOL.ORG

ACTIVITY ID: 19636

Name

Certifier

Date

Directions: Complete each section of this form so that you know the specific reporting procedures for your family child care. Please review your responses with your coach, trainer, or family child care administrator.

I report my suspicions to:

Name
Telephone Number
Address (if applicable)

I provide the following information:

Child's first name and last name
Parent or guardian's name and address
Reasons for suspected abuse or neglect
Description and location of injuries (if applicable)
Information freely disclosed by victim
Current location of victim
Known information regarding incident or chronology of events

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I report my suspicions to:

I provide the following information:

My family child care's standard operating procedures and policies are located:

I must follow these additional local reporting procedures:

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I report my suspicions to:

I provide the following information:

My family child care's standard operating procedures and policies are located:

I must follow these additional local reporting procedures:

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