Reporting Form

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Reporting Form

Email *

School staff, volunteers, and parents are responsible to report indicators, disclosures, or concerns regarding possible harassment or abuse. These reports should be given to a school administrator or member of the Child Safety Team within 24 hours. The report may be submitted using this form or by sending an email to pcschildsafetyteam@gmail.com. Please fill this form out with only the information that is known without researching or investigating the situation. When you make a report, you are not making an accusation, you are simply requesting for a professional service to be done.

Your first and last name *

Your email *

Date *

YYYY

Nature of the violation of the school's Child Safety Policy *

harassment

verbal abuse

physical abuse

inappropriate emotional relationship

inappropriate sexual contact/activity

Other:

Required

If you selected other, please provide details.

Name *

Grade/Position *

Name 1 *

Grade/Position 1 *

Relationship to the offended 1 *

Name 2

Grade/Position 2

Relationship to the offended 2

How was the concern obtained or observed? *

Details of what was reported or suspected. Please include dates, frequency, location, and what happened as accurately as you can. *

Are there any concerns regarding the accessibility of the person who has done the harm to the person(s) who has been, or is being harmed? *

Is there any other information you would like the school to be aware of?

Thank you for taking the time to complete this reporting form. PCS will follow procedures as outlined in the Child Safety Policy in processing this form. Please understand that an administrator, counselor, or Child Safety Team member may meet with you to further understand the situation.

A copy of your responses will be emailed to the address you provided.

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