Reporting Concerns Form - Policy • Berwick Church of Christ Inc.

Reporting Concerns Form - Policy

This Form should be completed if you believe, on reasonable grounds that:

You have a grievance or matter that cannot be informally resolved.
A person is in need of protection or at risk of significant harm,
A leader/volunteer is in breach of the Church's policies and procedures
A person's behaviour is likely to harm the reputation or financial well-being of the Church.

If your concerns relate to a child or person under the age of 18 years, please refer to the Child Safety Reporting Procedures.

DETAILS OF PERSON MAKING THE REPORT

First Name *

Mobile Number *

Your Leader/Pastor's Name *

Your relationship to the person of concern *

Last Name *

Email Address *

Your Role *

DETAILS OF PERSON OF CONCERN

First Name of Person/Child *

Gender *

Address of Person/Child *

Last Name of Person/Child *

Age *

Parent's or Guardian's Full Name (if Under 18)

DATE AND TIME OF INCIDENT/CONCERNS

Date of Incident/Report *

Time: (24 hour clock) *

DESCRIBE CONCERNS AND DISCLOSURES

Provide as much information as possible, based on facts and observations. *

PROCEDURES

If this concern is in relation to a person under the age of 18, please refer to the Child Safety Reporting Procedures (located at www.berwickchurch.org.au/policies).

Call 000 (emergency services) if there is immediate danger.
If someone is informing you of any concerns, listen carefully:
- If you're under 18, ask a Team Leader of Pastor to assist you.
- Interact as follows:
  - Support the person and reassure them
  - Limit questioning, ask only open questions
  - Don't make promises that cannot be kept
  - Include that the information will remain confidential, and tell the person who will be told and why
  - Document the conversation using the person's exact words as far as possible.
Write up the concern and any actions taken in response to the concern.
Report to the Police, if you have a reasonable belief of child sexual abuse. (If you are 18 or over, you are personally obliged to report to the poicye if you have a reasonable belief that a person who is 18 or older has committed or attempted to commit a sexual offence against a child who is under 16.)
Do not discuss your concerns with anyone else. If you need support contact the Safety Contact Person or a Pastor.
This completed report will only be forwarded to the Safety Contact Person.

Safety Contact Person: Karen Fletcher

Mobile: 0438 886 337

Email: karenf@bcoc.com.au

Church Office: 9702 1011 (Mondays to Thursdays only)