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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.

Question	Answer
Form Name	Ss8572 Form Abuse
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	suspected child abuse form, mandated reporter form california, child abuse form report, suspected child report form

12

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:

REPORTING	PARTY
A.
B. REPORT	NOTIFICATION

One Report Per Victim

C. VICTIM

	VICTIMS SIBLINGS
INVOLVED PARTIES	VICTIM’S PARENTS/GUARDIANS
D.
	SUSPECT
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)

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SS 8572 (12/02)

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portion of empty spaces in report cps form ca

Complete the IN FOSTER CARE, IF VICTIM WAS IN OUTOFHOME CARE AT, TYPE OF ABUSE CHECK ONE OR MORE, PHYSICAL, MENTAL, YES, RELATIONSHIP TO SUSPECT, DAY CARE GROUP HOME OR INSTITUTION, CHILD CARE CENTER, FOSTER FAMILY HOME, FAMILY FRIEND, RELATIVES HOME, NEGLECT, OTHER SPECIFY, and S M T C V fields with any particulars that are asked by the software.

report cps form ca IN FOSTER CARE, IF VICTIM WAS IN OUTOFHOME CARE AT, TYPE OF ABUSE CHECK ONE OR MORE, PHYSICAL, MENTAL, YES, RELATIONSHIP TO SUSPECT, DAY CARE GROUP HOME OR INSTITUTION, CHILD CARE CENTER, FOSTER FAMILY HOME, FAMILY FRIEND, RELATIVES HOME, NEGLECT, OTHER SPECIFY, and S M T C V fields to fill out

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