Suspected Abuse or Neglect Form

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URL

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Section 1: Contact Information

Name of Volunteer/Employee*

First Last

Phone*

Campus*

Today's Date*

Time*

Section 2: Child Information

Child's Name*

First Last

Approximate Age:*

Gender*

Parent/Guardian Name (if known):

Section 3: Reason for Concern

Describe exactly what you saw, heard, or were told, using the child’s words when applicable. Do not include opinions, diagnoses, or assumptions.

Location*

Campus, classroom, event, etc.

Description of observed behavior, statements, or physical signs:*

Is the child believed to be in immediate danger?*

Yes

If yes, was 911 contacted?*

Yes

Section 4: Individuals Involved or Witnesses

Names and roles of any individuals present:*

(Only if directly observed—do not speculate.)

Section 5: Mandatory Reporting Confirmation

Was Child Protective Services contacted?*

Yes

⛔ If CPS has not yet been contacted, this report must pause, and you must contact CPS immediately.

Child Protective Services Reporting Numbers:

Oklahoma Child Protective Services:
1-800-522-3511

Texas Child Protective Services:
1-800-252-5400

Colorado Child Protective Services:
1-844-264-5437

NOTE: If the child is in immediate danger, call 911 before you call child protective services.

Click “Save & Continue Later” below to save your progress.

Once you have contacted CPS, follow the instructions provided on the next screen to complete this form.

Date & Time CPS was contacted:*

Method of Report:*

Phone

Online

Reference or Case Number (If Provided):

Section 1: Contact Information

Section 2: Child Information

Section 3: Reason for Concern

Section 4: Individuals Involved or Witnesses

Section 5: Mandatory Reporting Confirmation

Locations