Persons of Concerns Form - CARINGBAH

Once completed, this form will be emailed to our Safe Church Team who will follow the Procedure for Responding to Child Protection Concerns.

This completed form, and attached documents must be kept in a locked filing cabinet and/or in secure electronic
format for at least 45 years from the date of completion.


Please do not discuss the concern with anyone other than the Safe Church Team or your Ministry Team Leader.


If there is immediate danger please contact police immediately.

Details of Person Completing this form:

Details of alleged victim (if applicable):

Details of the alleged perpetrator:

Nature of the allegation:

My declaration:

The information I have provided is the truest information and version of events as I recall them. I understand that this information will be held in strict confidence, but can be used in legal proceeedings should the need arise. 

FOR SAFE CHURCH TEAM USE ONLY:

Other government agencies or departments involved:

POLICE:

DCJ/CYPS:

OCG/Ombudsman: