Child Safety Standards Incident Report - City of Bayswater

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Child Safety Standards Incident Report

All incident reports must be stored securely, and password protected to maintain confidentiality. Please advise your Direct Line Leader when lodging this incident report. If you believe a child is at immediate risk of abuse phone 000.

Incident details

Date of incident

MM slash DD slash YYYY

Time of incident

Hours

:

Minutes

AM/PM

Location of incident

Date Identified (if different from date of incident)

Name(s)/Detail of child/children involved

Name(s) of staff/student/volunteer involved:

Please categorise the incident and/or provide comments below

Physical violence

Sexual offence

Sexual misconduct

Serious emotional or psychological abuse

Serious neglect

Grooming

Breach of the University’s Child Safe Code of Conduct

Reportable Conduct

Comments

Does the child identify as Aboriginal or Torres Strait Islander?

No

Yes, Aboriginal

Yes, Torres Strait Islander

(Mark with an ‘X’ as applicable)

Is the child from a culturally or linguistically diverse background?

No

Yes

(Mark with an ‘X’ as applicable)

If yes, please provide details

Does the child have a disability?

No

Yes

A disability can be any physical, sensory, neurological disability, acquired brain injury, intellectual disability, or developmental delay that affects a child’s ability to undertake everyday activities (Mark with an ‘X’ as applicable).

If yes, please provide details

Please describe the incident

Overview

When did it take place & what were the circumstances?

Who was involved?

What did you see/hear?

Other information

Proposed corrective action & mitigation plan

Action

Responsible Person

Date (Completion)

MM slash DD slash YYYY

Status

Action

Responsible Person

Date (Completion)

MM slash DD slash YYYY

Status

Action

Responsible Person

Date (Completion)

MM slash DD slash YYYY

Status

Details of person reporting the incident

Department of reporter

(if/where applicable)

Contact details of reporter

Name of person reporting the incident

Office use only

Date incident report received

Staff member managing incident

Incident ref. number

Has the incident been reported?

Child Protection

Date Notified

MM slash DD slash YYYY

Comments

Police

Date Notified

MM slash DD slash YYYY

Comments

Commission for Children and Young People

Date Notified

MM slash DD slash YYYY

Comments

Another third party (please specify)

Date Notified

MM slash DD slash YYYY

Comments

Δ

The City of Bayswater acknowledges the Traditional Custodians of the land, the Whadjuk people of the Noongar Nation, and pays its respects to Elders past, present and emerging.

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Civic Centre and Council Chambers
61 Broun Avenue, Morley
PO Box 467 Morley 6943

mail@bayswater.wa.gov.au

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The RISE
Health Club

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Weekends: 8:00am-6:00pm

Public Holidays: 9:00am-6:00pm

ANZAC Day: 12:00pm-6:00pm

Closed Good Friday & Christmas Day

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Weekends: 8:00am-6:00pm

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ANZAC Day: 12:00pm-6:00pm

Closed Good Friday & Christmas Day

Morley Rec
Health Club

Weekdays: 5:30am-9.00pm

Weekends: 8:00am-6:00pm

Public Holidays: 10:00am-4:00pm

ANZAC Day: 12:00pm-6:00pm

Closed Good Friday & Christmas Day

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Weekends: 9:00am-5:00pm

Public Holidays: 9:00am-5:00pm

ANZAC Day: 9:00am-5:00pm

Water Features Closed Good Friday & Christmas Day

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