HOPE Child Safety Reporting Form
Please complete this report of suspected self harm, abuse or neglect, within 24 hours of witnesing or being disclosed to.

This form will be sent directly to the Director and the Child Safety Coordinator.

All reports received will be dealt with according to the HOPE Child Safety Policy.

If concerns exist about a student’s immediate safety, you must ensure their safety in conjunction with the Director or one of the Principals and then complete the report.

You may at all times ask the HOPE Director if the matter is being followed up.

Email address *
Name of person completing this report *
Your answer
Date of completing this report *
MM
/
DD
/
YYYY
Time of completing this report
Time
:
Name of person observed or disclosing information *
Your answer
Where did the disclosure/observation take place? *
Your answer
When did the disclosure/observation take place? *
MM
/
DD
/
YYYY
Summary of what was observed/disclosed:
Include information that was disclosed/observed; questions asked and answers received: Describe reaction to questions during disclosure.
*
Your answer
Emotional state of person being observed/disclosing *
Required
Other relevant information you would like to share
Your answer
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This form was created inside of HOPE International School.