Mandatory Notification Report

Complete this form when reporting concerns about abuse, harm or risk of harm to the Child Abuse Report Line (CARL) on 13 14 78.

Contact details at the top of this form are for the person completing the report.

Include the frequency and nature of your contact with them

Details of Child or Young Person

Please include "Also Known As" or alternative names or surnames

If known

When making your report you will need to give as much information as possible to the call taker.

Please consider the following:

POTENTIAL SOCIAL DISADVANTAGES
eg. Aboriginal, Torres Straight Islander, Living with a Disability, Under Guardianship, Non-English Speaking

FAMILY DYNAMICS
eg. Separated Parents, Custody, Family Court Orders, Parent with a New Partner, Family History (inc violence, drug or alcohol abuse, mental health problems), Available Support Networks

YOUR CONCERNS
eg. Something was disclosed to you, You saw or heard something, You have seen evidence of abuse, Behaviours have changed, Who is a potential perpetrator, Is the person in immediate danger

Notification

If you believe the child or young person is in immediate danger you must call CARL immediately (do not use the eCARL system)

Date

Please note any Senior Leaders or Pastors who you may have consulted with during this process.

eg advice received in conversation with CARL

Form Completion

Once complete, this form will be printed by admin and stored in a secure file in the accounts office. Thank you.

Please list all witnesses to this account and the date next to your name

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