Disclosure of Harm Report Form

A disclosure of harm occurs when someone, including a child, tells you about harm that has happened, is happening, or is likely to happen to a child. A disclosure of harm exists if:
- A child tells you they have been harmed.
- Someone tells you or makes an accusation that harm has occurred to a child.
- You tell a Volunteer/Staff that you have harmed or witnessed the harm of a child.

BEFORE COMPLETING THIS FORM...
Is anyone in immediate danger or in a life threatening situation?
If yes, call the QLD Police on 000.
If no, check the next question.

Have you informed Graham and/or Shane?
If no, call Graham now on 0404 170 005 or Shane on 0404 253 462
If yes, complete the form below.

Details of the person making this report

Name

Phone

This address will receive a confirmation email

Details of the Disclosure

Names of RBC Staff/Volunteers who recived the disclosure

Location of disclosure

Date of disclosure

Time of disclosure

Name (and any known contact details) of the person who made the Disclosure

Details of what was disclosed (include as much detail as possible)

REMINDER - Australian law dictates that any adult with knowledge of an offence of a sexual nature being committed in relation to a child must report it to the Police, even if the information was gained during a religious confession.

Is there any other information you can provide?

Have any actions been taken by Staff/Volunteers of RBC in relation to the disclosure at the time of reporting?

Description

Please fill out this form and click submit.

Disclosure of Harm Report Form

Description

Please Fix the Following