SUSPECTED CHILD ABUSE INCIDENT REPORT - epworth-umccom 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and position in the designated fields for the worker observing or receiving disclosure of child abuse.
3. Fill in the victim’s name, age, and date of birth. Ensure accuracy as this information is crucial for reporting.
4. Document the date and place of the initial conversation with the victim. This helps establish a timeline for the report.
5. Provide a detailed summary of the victim’s statement in the appropriate section. Be thorough and clear to convey all necessary information.
6. Enter the name of the person accused of abuse along with their relationship to the victim, selecting from options like paid staff, volunteer, or family member.
7. Record the date and time when you reported this incident to your pastor, ensuring that you include AM/PM notation.
8. Complete sections regarding communication with the victim's parent/guardian, including who placed the call and a summary of that conversation.
9. Finally, sign and date your report before returning it to the Church Administrator as instructed.

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