SC Reporting

ABC Safe Church Reporting Form

This form can be used to report the following:

Feedback/Complaint - For any feedback that you would like the pastoral staff and elders to be aware of and to express dissatisfaction or report a concern about ABC related to staff, leadership, members, volunteers or related ministries.

Accident / Medical Injury - Complete when an accident or incident involving physical injury or property damage has occurred.

Anecdotal Report - To be completed by a leader who wishes to report concerns about another person, either relating to the code of
conduct; or concerning behavior either in a leader or program participant. This includes raising concerns of abuse.

This form is not to be used for any disclosures or reports relating to any child or young person at risk of harm (abuse). This needs to be completed via an official form available here: Risk of Harm Form

Please note that form fields are triggered as you input information so please make sure you scroll after entering each field to make sure you have completed the entire form.

Date

Time

Your Full Name

Your current position in church

Phone Number

Home Address

Kind of Report

Nature of report

Date of incident or observation

Time of incident or observation

Please detail your complaint or feedback in the box below.

Location where incident happened

Please provide a description of incident / what occurred

Were you directly involved in the incident

Name of person involved

Address of Person involved

Phone number of person involved

Were there any witnesses?

Witness Name

Witness Address

Witness Phone Number

Risk Assessment

This incident occurred due to a risk or hazard

The risk or hazard was identified prior to incident

The risk was controlled prior to the incident

Tip: Select all that apply

What measures were used to control or eliminate the risk/hazard?

Could any further action be taken to reduce this incident from occuring again?

Name of Team Leader

Name of Child

Age of Child

Your relationship to child

Provide a description of your observations, concerns and what was said

Tip: Note: It is important to provide as much information as possible, basing your information on facts and observations, without making assumptions; jumping to conclusions, or making ‘value’ judgments.