Indicator of Child Safety Concern Reporting Form
HAB staff members and volunteers are responsible to report any suspicion, concern, or disclosure of any child being at risk of harm, whether in school or outside of school, within 24 hours using this form. Please complete only the information known at the time of the disclosure or observation.

Students, parents, and other community members may also use this form for current or historical allegations.

Please answer these questions to the best of your ability. Leave unknown information blank.

This form is received by the Child Safety Officer at safeguarding@hopeacademykg.com.
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What is your name?
Your contact details (email/phone number)
What grade or postion are you in?
Details of what was disclosed, observed, or suspected (Times, dates, sequence of events, actual words used).
How was this information disclosed, observed, or suspected?
Have you consulted or spoken to anyone else about this? If so, whom?
Is there any other information that we should know?
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