Safe Ministry | Report a Concern Form • Emu Plains Anglican Church Online Community

Safe Ministry | Report a Concern Form

Use this form to report a concern about a risk of harm to the well-being of a child or adult at our church.

Person making report

First Name *

Last Name *

Contact (phone/email)

Person affected

First Name *

Last Name *

Contact (phone/email)

Child or Adult? *

Child

Adult

Parent/caregiver details

First Name

Last Name

Contact (phone/email)

Concerns for the child/vulnerable person

Record a full account of your concerns for the safety, well-being or welfare of the child or vulnerable person. Include as much detail as possible, as well as relevant dates and times.

Include anything observed: Indicators, behavioural changes, safety concerns, verbal comments or conversations.

Response *

Next steps

Parent advised *

Any additional action?

Declaration

I acknowledge this form is complete and accurate to the best of my knowledge. *

Yes