Child Protective Services Reporting Form Indiana Child Abuse & Neglect Hotline: 1-800-800-5556
Child Protective Services Reporting Form Indiana Child Abuse & Neglect Hotline: 1-800-800-5556
Child Protective Services Reporting Form Indiana Child Abuse & Neglect Hotline: 1-800-800-5556
As of July 1, 2017, IC 31-33-5-2 now requires the school employee to immediately report suspected child abuse or neglect to the Department
of Child Services (DCS) or to a local law enforcement agency, and then notify the principal or principal’s designee that a report has been
made. The new law requires the first person in the school to be informed of the suspected child abuse or neglect be the person who should
report the matter immediately. Follow up calls can be made if necessary.
Date person(s) making report were made aware of abuse or neglect: ______________
Person with whom the student lives (if other than parent(s)): ___________________
Identity of the person(s) alleged to have caused injury, abuse, or neglect: ______
Is the person(s) alleged to have caused the injury, abuse, or neglect a [your school name here] employee? Y___ N___
If yes, name and position:_________________________________
Is the person(s) alleged to have caused the injury, abuse, or neglect a [your school name here] student? Y___ N___
If yes, name and grade:__________________________________
Alleged perpetrator’s address if other than parent/guardian: _______________________
Did the incident occur in school, on school grounds, at a school-related activity, or on the bus?_____________
Description of any known previous injuries, abuse, or neglect: ______________________
Are there any drugs/weapons in the home?_________ Are there any pets/dangerous animals in the home?__________
Has there been any domestic violence in the home?__________
Is there anyone in the whole who uses drugs or other behavior altering substances?___________
Are you aware of anyone living in the home who is involved in gang activity?___________