UCA - Persons of Concern Notification Form

Full Name

Phone Number

Your position held in the Uniting Church

Congregation/ Presbytery/Uniting organisation

Name of the person you know or suspect to be a Person of Concern

Outline the reason for your concern – include time, date, location and what happened if there has been an event which caused concern (this can include observations of a child’s behaviour if applicable).

Details of any injuries or medical attention (if applicable)

Accurately record what the child said when describing what happened (if applicable) (In the case of an allegation of abuse, formal investigations and interviews will be carried out by Family and Community Services and/or NSW Police. You must record what the child has said but unless it is your role to investigate, you should not interview the child).

Details of anyone who saw what happened.

Does this complaint indicate the possibility of child abuse, i.e. physical abuse, sexual abuse, or neglect?

Yes

Does this complaint indicate the potential of a person of concern being associated with your church or UCA organisation?

Yes

Is there reason to believe a child or adult is in immediate danger of significant harm?

Yes

In the case of suspected child abuse has a report been made to?

DCJ (via child story link)

DCJ – (via Child Protection Hotline 132 111)

Office of the Children’s Guardian website

Child and Youth Protection Services (ACT)

People spoken to (including dates)

Click to close this notice

Thank you for notifying us of a person of concern.

Click to close this notice

We apologise, your attempt at reporting was unsuccessful.

Staff

Managers

Committees

Shared Resources

Persons of Concern Notification Form