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SUSPECTED CHILD ABUSE INCIDENT REPORT - epworth-umccom 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your name and position in the designated fields for the worker observing or receiving disclosure of child abuse.
- Fill in the victim’s name, age, and date of birth. Ensure accuracy as this information is crucial for reporting.
- Document the date and place of the initial conversation with the victim. This helps establish a timeline for the report.
- Provide a detailed summary of the victim’s statement in the appropriate section. Be thorough and clear to convey all necessary information.
- 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.
- Record the date and time when you reported this incident to your pastor, ensuring that you include AM/PM notation.
- Complete sections regarding communication with the victim's parent/guardian, including who placed the call and a summary of that conversation.
- Finally, sign and date your report before returning it to the Church Administrator as instructed.
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