Program Tool
Program Tool

Reporting Log

Virtual Lab School Management Child Abuse: Identification & Reporting Lesson 5 Apply Reporting Log
Program Tool
WWW.VIRTUALLABSCHOOL.ORG
ACTIVITY ID: 15396
Name
Certifier
Date

Share this form with staff members to document and maintain records of what they observe. It can be useful when reporting suspicions of child abuse and neglect. Be sure, though, that all observations or records of reports are kept separate from the child's files in the office to maintain confidentiality.

Child's Name
Today's Date
 
 

 

What signs or symptoms were observed? Be specific. Include information about what the child or adult said and the location of the injury on the child's body.
 
What time and date were the signs or symptoms originally observed?
 
Where was the observation made (e.g., classroom, playground)?
 
Who made the observation?
 
What steps were taken? Who was contacted or notified (i.e., FAP, CPS, law enforcement)? Include the name of the person or agency contacted and the date and time of contact.
 
Was the family notified? If so, include the name of the person contacted and the date and time of contact.
 

 

Notes (Describe any follow-ups or special circumstances impacting this event.)