Report of Possible Child Abuse 疑似兒童虐待事件通報表
School employees and volunteers are responsible to report any disclosures or other evidence
of possible child abuse. These reports must be sent to the Principal or Director of Boarding
within 24 hours. The report may be submitted using this form. Please fill this form out with
only the information that is known at the time the allegation is received, without interviewing
the victim(s) or alleged offender(s).
學校教職員和義工有責任通報任何確定或疑似兒童虐待之事件。通報單必須於 24 小時內 送交
校長或總舍監,您可以填寫以下表格,填畢將紙本親自送交校長或總舍監。請注意: 僅需填寫
該疑似受虐事件的事發狀況,請勿對疑似受虐者或疑似施虐者進行任何訪談。
Alleged victim 疑似受虐者
姓名Name of Alleged Victim
Your answer
性別Sex
就讀年級Grade
Your answer
父親姓名Father’s Name
Your answer
母親姓名Mother’s Name
Your answer
Alleged perpetrator 疑似施虐者
Name of Alleged perpetrator 姓名
Your answer
How the info was obtained or observed 如何得知或觀察到受虐資訊
Your answer
Details of what was reported or suspected 案情陳述
Dates 發生時間 (YYYYMMDD):
Your answer
Frequency 發生頻率:
Your answer
Places 發生地點:
Your answer
What happened (Quote exactly the spoken words as much as possible.) 案發經過 (儘可能記錄實際的對話):
Your answer
Things done to protect the alleged victim(s) 對疑似受虐者已採取的保護措施
Your answer
Person filing the report 通報人
Name of Person filing the report 姓名
Your answer
Report Date 通報時間
MM
/
DD
/
YYYY
Report Time 通報時間
Time
:
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