Safeguarding Concern Report – Safeguarding Program Office

Safeguarding Concern Report Form

If you have concerns for the immediate safety of a child or adult call 000.

Download The Safeguarding Responding and Reporting Abuse Quick Guide to help you understand the reporting process.

Anyone can use this form to report all abuse or concerns about the well-being of a child or adult or a safeguarding incident within the Catholic Archdiocese of Perth.

All concerns, allegations or complaints will be taken seriously and treated with sensitivity. Matters will be acted on in accordance with the Archdiocesan Privacy Policy and with moral, ethical and legal obligations.

It is a legal requirement for Mandated Reporters (Children and Community Services Act 2004) who form a belief on reasonable grounds, to report child sexual abuse to the Department of Communities’ Mandatory Reporting Service.

The Catholic Archdiocese of Perth is to comply with the Reportable Conduct Scheme to report Reportable Conduct and Convictions by notifying the Ombudsman of allegations of, or convictions of child abuse by employees (paid, volunteer, contractor, minister of religion and certain carers and educators).

If you require assistance completing this e-form, please contact the Director, Safeguarding Program on +61 (08) 9221 7762.

If you would prefer to use a Word version, please Download .

I am providing(Required)

My own report (I am the Victim or Witness)

A report on behalf of someone else (I am helping another to report)
Full Name
First Name Last Name
THIS SECTION IS FOR RECORDING DETIALS OF THE PERSON YOU ARE REPORTING ON BEHALF OF. IF THEY WISH TO REMAIN ANONYMOUS MARK "ANONYMOUS"
Phone
Email

They have a role in the Archdiocese (E.G. Clergy/Religious/Employee/Volunteer/Safeguarding Officer)
Please specify exactly what role and what location in the Archdiocese or mark Not Applicable(N/A)
Location (Parish/Agency/Office/Ministry or N/A)

Does the concern involve a child under the age of 18 years?(Required)

Yes

No
IF YOU HAVE CONCERNS FOR THE IMMEDIATE SAFETY OF THIS CHILD, CONTACT OOO OR THE DEPARTMENT OF COMMUNITES - CHILD PROTECTION OFFICE ON 1800 273 889.
Please select which of the following the report is about:(Required)
Other:(Required)
Name of the person or location/address you are reporting about:(Required)
Full Name and Location/Address
Detailed Report
Please provide as much detail as possible:(Required)
Please upload any additional information.
Max. file size: 128 MB.
Your details:
Would you like to remain anonymous?
Yes
Full Name(Required)
First Name Last Name
THIS SECTION IS TO RECORD YOUR DETIALS AS THE REPORTER. NOT WHO YOU ARE REPORTING ON BEHALF OF.
Phone(Required)
Email(Required)

I have a role in the Archdiocese (E.G. Clergy/Religious/Employee/Volunteer/Safeguarding Officer)(Required)
Please specify exactly what role in the Archdiocese or mark Not Applicable(N/A)
Location (Parish/Agency/Office/Ministry or N/A)(Required)
Please note:
IF YOU WISH TO REMIAN ANONYMOUS YOUR SUBMISSION WILL BE RECIEVED, HOWEVER WE MAY BE UNABLE TO PROGRESS THIS MATTER OR PROVIDE YOU WITH ANY FEEDBACK.
Please note:
ONCE SUBMITTED A SAFEGUARDING PROGRAM OFFICE REPRESENTATIVE WILL CONTACT YOU.
Thank you
Comments
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