Ss8572 Form Abuse PDF Details

In today's society, there are many different types of abuse that people can experience. One type of abuse that is often overlooked is ss8572 form abuse. This type of abuse occurs when someone uses their position of authority to take advantage of someone else. Ss8572 form abuse can be very damaging to the victim and can leave them feeling helpless and alone. If you or someone you know is experiencing ss8572 form abuse, it is important to seek help immediately. There are many resources available to victims of ss8572 form abuse, and you don't have to face this situation alone.

You can find information regarding the type of form you want to complete in the table. It can tell you the amount of time you'll need to complete ss8572 form abuse, what fields you will need to fill in and some further specific facts.

QuestionAnswer
Form NameSs8572 Form Abuse
Form Length2 pages
Fillable?Yes
Fillable fields95
Avg. time to fill out19 min 34 sec
Other namessuspected child abuse form, report child abuse form, mandated reporter form california, cps report form

Form Preview Example

NARRATIVE DESCRIPTION

SUSPECTED CHILD ABUSE REPORT

To Be Completed by Mandated Child Abuse Reporters

 

Pursuant to Penal Code Section 11166

CASE NAME:

PLEASE PRINT OR TYPE

CASE NUMBER:

<![endif]>REPORTING

<![endif]>PARTY

<![endif]>A.

 

<![endif]>B. REPORT

<![endif]>NOTIFICATION

<![endif]>One Report Per Victim

<![endif]>C. VICTIM

 

<![endif]>VICTIMS SIBLINGS

<![endif]>INVOLVED PARTIES

<![endif]>VICTIM’S PARENTS/GUARDIANS

<![endif]>D.

 

 

<![endif]>SUSPECT

<![endif]>E. INCIDENT INFORMATION

 

NAME OF MANDATED REPORTER

 

 

 

TITLE

 

 

 

 

 

 

 

 

 

 

MANDATED REPORTER CATEGORY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DID MANDATED REPORTER WITNESS THE

REPORTER’S BUSINESS/AGENCY NAME AND ADDRESS

 

 

Street

 

 

 

 

 

City

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INCIDENT?

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TODAY’S DATE

 

 

 

 

 

 

 

 

REPORTER’S TELEPHONE (DAYTIME)

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAW ENFORCEMENT

COUNTY PROBATION

AGENCY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTY WELFARE / CPS (Child Protective Services)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

Street

 

 

 

 

 

City

 

 

 

 

 

 

 

 

Zip

 

 

 

 

DATE/TIME OF PHONE CALL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICIAL CONTACTED – TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE OR

 

APPROX. AGE

 

 

SEX

 

 

ETHNICITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

Street

 

 

 

 

 

City

 

 

 

 

 

 

 

 

Zip

 

 

TELEPHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRESENT LOCATION OF VICTIM

 

 

 

 

 

 

SCHOOL

 

 

 

 

 

 

 

 

 

 

CLASS

 

 

 

 

 

 

GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHYSICALLY DISABLED?

DEVELOPMENTALLY DISABLED?

 

 

OTHER DISABILITY (SPECIFY)

 

 

 

 

PRIMARY LANGUAGE SPOKEN IN HOME

 

YES

NO

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN FOSTER CARE?

IF VICTIM WAS IN OUT-OF-HOME CARE AT TIME OF INCIDENT, CHECK TYPE OF CARE:

 

 

TYPE OF ABUSE (CHECK ONE OR MORE)

 

YES

 

DAY CARE

 

 

CHILD CARE CENTER

FOSTER FAMILY HOME

FAMILY FRIEND

 

PHYSICAL

 

 

MENTAL

 

SEXUAL

 

 

 

 

 

NEGLECT

 

 

 

 

 

 

 

 

 

NO

 

GROUP HOME OR INSTITUTION

RELATIVE’S HOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER (SPECIFY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RELATIONSHIP TO SUSPECT

 

 

 

 

 

 

 

 

 

 

 

 

 

PHOTO’S TAKEN?

 

 

DID THE INCIDENT RESULT IN THIS VICTIM’S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

DEATH? YES

 

NO

 

 

 

UNK

1.

 

 

NAME

BIRTHDATE

SEX

ETHNICITY

 

3.

 

 

 

 

NAME

 

 

 

BIRTHDATE

 

 

SEX

 

 

ETHNICITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE OR APPROX. AGE

 

 

SEX

 

ETHNICITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

Street

 

 

 

City

 

 

 

Zip

 

 

 

HOME PHONE

 

 

 

 

 

 

 

 

BUSINESS PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE OR APPROX. AGE

 

 

 

SEX

 

ETHNICITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

Street

 

 

 

City

 

 

 

Zip

 

 

 

HOME PHONE

 

 

 

 

 

 

 

 

BUSINESS PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

SUSPECT’S NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE OR APPROX. AGE

 

 

 

SEX

 

 

ETHNICITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

Street

 

 

 

City

 

 

 

Zip

 

 

 

HOME PHONE

 

 

 

 

 

 

 

 

BUSINESS PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

OTHER RELEVANT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF NECESSARY, ATTACH EXTRA SHEET(S) OR OTHER FORM(S) AND CHECK THIS BOX

IF MULTIPLE VICTIMS, INDICATE NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE / TIME OF INCIDENT

 

 

PLACE OF INCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(What victim(s) said/what the mandated reporter observed/what person accompanying the victim(s) said/similar or past incidents involving the victim(s) or suspect)

SS 8572 (Rev. 12/02)DEFINITIONS AND INSTRUCTIONS ON REVERSE

DO NOT submit a copy of this form to the Department of Justice (DOJ). The investigating agency is required under Penal Code Section 11169 to submit to DOJ a Child Abuse Investigation Report Form SS 8583 if (1) an active investigation was conducted and (2) the incident was determined not to be unfounded.

WHITE COPY-Police or Sheriff’s Department; BLUE COPY-County Welfare or Probation Department; GREEN COPY-District Attorney’s Office; YELLOW COPY-Reporting Party

SS 8572 (12/02)

Page 1 of 2

Clear Form

Print Form

SS 8572 (12/02)

Page 2 of 2

How to Edit Ss8572 Form Abuse Online for Free

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Complete the DEVELOPMENTALLY, DISABLED YES, YES, OTHER, DISABILITY, SPECIFY IN, FOSTER, CARE DAYCARE, GROUP, HOME, OR, INSTITUTION CHILDCARE, CENTER RELATIVES, HOME FOSTER, FAMILY, HOME FAMILY, FRIEND YES, NO RELATIONSHIP, TO, SUSPECT NAME, BIRTHDATE, and SEX fields with any particulars that are asked by the software.

suspected child abuse report DEVELOPMENTALLYDISABLED, YES, YES, OTHERDISABILITYSPECIFY, INFOSTERCARE, DAYCAREGROUPHOMEORINSTITUTION, CHILDCARECENTER, RELATIVESHOME, FOSTERFAMILYHOME, FAMILYFRIEND, YESNO, RELATIONSHIPTOSUSPECT, NAME, BIRTHDATE, and SEX fields to fill out

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