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My Program's Reporting Procedures

Program Tool

WWW.VIRTUALLABSCHOOL.ORG

ACTIVITY ID: 26716

Name

Certifier

Date

Directions: Review each section of this form with staff to ensure that they know specific reporting procedures for your program.

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

My programs standard operating procedures and policies are located:

I must follow these additional local reporting procedures: