DISCLOSURE REPORT FORM

This form is used to report any suspicion, allegation, or disclosure of child abuse, or any concern relating to the wellbeing of a child. Following a disclosure by a child, schools must be informed immediately and their internal reporting processes completed without delay. Kids Hope must then be notified by submitting this form on the same day the disclosure occurs.

Full Name:

Role: eg. Mentor, Coordinator, chaplain etc

School name:

Briefly describe (1–3 sentence summary) the information directly reported by the child or young person. Include factual details only, using the child’s own words where possible:

Details of any injuries and if the child/young person received medical attention:

Any treatment or action taken (by the school or others):

Date of report given to Principal:

Contact Information