Raising A Concern: Child Safety Report 兒童安全通報表

Morrison Academy employees and volunteers are responsible to use this form to report any suspicion, concern or disclosures of any child being at risk of harm, whether in school or outside of school, within 24 hours to the Child Safety Team. Morrison Academy's Child Safety Officer will promptly respond to this report.

Students, parents, alumni, community members or visitors are welcome to use this reporting form.

This form may also be used to disclose any historical allegations.

Please fill this form out to the best of your ability. If you do not know the answer to a question please just leave the section blank.

For any questions, please feel free to contact Morrison Academy's Child Safety Officer at childsafetyofficer@ma.org.tw.

馬禮遜學校教職員和志工有責任在24小時內向兒童保護團隊通報任何疑似、擔憂或揭露兒童有受到傷害風險的情況，無論該情況是在校內還是校外發生的。

學生、家長、校友、學校社群成員或訪客均可使用此通報表。

此表格亦可用於通報任何以前發生的爭議事件。

請儘您所知的情況填寫此表格。對於任何問題，如果您不確定其答案，請勿作答。

如果您有任何疑問，請與馬禮遜學校的兒童保護主管聯絡，電子郵箱: childsafetyofficer@ma.org.tw。

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Your name 您的姓名 *
Your job, position or grade 您的職業及職稱 (學生請填寫就學年級) *
Your contact details (email & phone number) 您的詳細聯絡方式 (電子郵箱 & 電話號碼) *
Name of child harmed or at risk 受到傷害或處於危險中的兒童姓名
Gender/Age/Grade 兒童性別/年齡/就學年級
Parents' names of the child harmed or at risk 兒童的父母姓名
Siblings names (if any) 兒童的兄弟姐妹姓名 (如果有的話)
Brief description of what prompted concern. 簡要說明引起關注的原因
How the info was disclosed, observed or suspected? 相關資訊是如何被揭露、觀察到、或引起懷疑?
Details of what was disclosed, observed or suspected (Times, dates, sequence of events, actual words used, observations, as many names as possible). 被揭露、觀察到、或引起懷疑的詳細資訊 (發生時間、日期、事件經過、實際對話內容、觀察內容)
Are there any immediate concerns regarding the accessibility of the person(s) who has caused the harm to the child harmed or at risk? 疑似施虐者是否容易接近該兒童? 此狀況是否需緊急處理?
Have you consulted or spoken to anyone else about this? 您是否跟其他人諮詢或談論過此事?
Is there any other information you would like to give? 您是否還要提供其他資訊?
Thank you. Morrison Academy's Child Safety Officer will confirm that this report has been received. If there are any other concerns, please write to childsafetyofficer@ma.org.tw. 謝謝您! 馬禮遜學校的兒童保護主管收到此通報表後會與您聯絡。如果您有其他意見或疑慮，請以電子郵件聯絡。信箱:  childsafetyofficer@ma.org.tw。
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