Tickit on Demand - St Vincent de Paul Society Qld

Child Safety Concern Report Form

Use this form to document any child safety concern. If in any doubt about whether something is a child safety concern, always document and report it.

IF SOMEONE IS IN IMMEDIATE DANGER, CALL 000, AND THEN COMPLETE THIS FORM

Privacy Statement

St Vincent de Paul Society Queensland and St Vincent de Paul Society Queensland Housing (together, the Society) collect personal information, sensitive information and information relating to children and adults at risk through this form.

We collect, use and disclose this information for the purposes of assessing, investigating and responding to safeguarding concerns and allegations of reportable conduct; protecting the safety and wellbeing of children and adults at risk; managing risks and support needs; and complying with our legal, regulatory and safeguarding obligations, including obligations under the Queensland reportable conduct legislation.

Information provided through this form may include information about the person making the report and other individuals involved in, affected by, or connected to the matter being reported. While the Society takes reasonable steps to protect confidentiality and privacy, the Society may disclose information to relevant employees, officers and volunteers, external investigators, regulators, child protection agencies, law enforcement bodies, legal advisers, insurers, professional advisers and other parties where reasonably necessary to assess, investigate or respond to the matter, or where required or authorised by law.

Reports may be submitted anonymously. However, anonymity or incomplete information may limit our ability to seek further information, or investigate the matter. If sufficient information is not provided, we may be unable to investigate or respond effectively to the report.

Information collected through this form will be managed in accordance with our Privacy Policy, safeguarding requirements including our Reportable Conduct Scheme Policy and applicable record retention obligations.

Further information about how the Society handles personal information, including how to access or correct personal information, how to make a privacy complaint, and whether personal information is disclosed overseas is available in our Privacy Policy (available through the Society’s website).

Can the Society contact you in regard to your concern/s?^*

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Child Safety Concern Report Form

Use this form to document any child safety concerns.

If in any doubt about whether something is a child safety concern, always document and report it.

Please provide all relevant and known details as accurately as able.

1. Details of Affected Child:

Please provide known details of the affected child

Person reporting the concern (if not Affected Child)

Name of Person Reporting:

Date of Birth of Person Reporting

DD/MM/YYYY

Role (if engaged by SVDPQ):

Relationship to affected child (if relevant)

Contact Details of Person Reporting the Concern:

Phone:

Email:

Preferred contact method:

Select all preferred

EmailPhone Call

Nature of the Concern

If the concern was disclosed by the affected child or another person, as far as possible record the nature of the concern using their own words.

Accurately record the date of the safety concern, what happened, who was involved, relevant issues, and details of any witnesses:

Risk Management

Provide details of identified risks and the actions taken to manage them.

Person Completing this Form

This person may be the same person reporting the concern.

Full name of person completing this form:

Role of person completing this form:

Date form completed: