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Online Reporting Form for Child Sexual Abuse

Introduction

Welcome to LICO’s online reporting form. Your participation is crucial in the fight against child sexual abuse. This platform is designed to empower survivors and whistleblowers to report incidents safely and confidentially.

What is Child Sexual Abuse?
Child sexual abuse refers to any sexual activity with a child, including exploitation, coercion, or grooming. It can have devastating effects on survivors, leading to emotional, psychological, and physical harm.

Impacts of Child Sexual Abuse:

  • On Children: Survivors, both girls and boys, may experience long-term trauma, affecting their mental health, development, and future relationships.
  • On Communities: The repercussions extend to families and communities, leading to a cycle of violence and vulnerability.
  • On the World: Child sexual abuse undermines human rights and development, impacting societal stability and safety.

Importance of Reporting:
Reporting is a critical step in addressing child sexual abuse. It allows for timely intervention, support for victims, and helps authorities take necessary action against perpetrators. Every report contributes to the protection of children and the strengthening of community safety.

Confidentiality and Privacy:
We are committed to protecting your identity and ensuring your privacy. All reports will be handled confidentially, and your information will be safeguarded to encourage more individuals to come forward.

Providing Important Information:
When reporting, it’s essential to provide as much detail as possible. This information assists authorities in following up on the case effectively, ensuring a thorough investigation and support for the survivor.

This form may also be completed in Chichewa or Chitumbuka languages.

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Full names (Optional)
Phone number *
Your Relationship to the Child or Survivor  *
Date of Incident *
MM
/
DD
/
YYYY
Location of the Incident *
Tell us more about the place where the incident took place. This may include a specific T/A, Village, Community, Work place or any other easily recognisable location
Are you able to mention any witnesses at the occurrence of the incidence? *
Please state the names or descriptions if known.
Clearly mention the perpetrator or describe the physical features for easy identification *
Description of Incident *
Please describe what happened, include the name and age of the survivor.
Any Prior Reports or Actions Taken *
Clearly state if this incident has been reported before and any actions taken so far. Type NO or N/A if no prior reports or action taken
Additional Comments or Information *
Please tell us any other information which you think is relevant, but it has not been shared in the above discussions.
Do you have any supporting materials or documents that would validate your report? If yes, please WhatsApp them to +265991399880 *
Do you wish to be kept anonymous? *
Thank You

Thank you for taking the time to report this important issue. Your action can help protect children and bring awareness to this critical concern. If you need personal feedback or support regarding your report, please call us at +265991399880.

Together, we can make a difference!

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