DFS - Clients - Child Safety Report Form

Child Safety Report

Today's Date and Time *

I am a: *

Child or young personParent/Guardian or representative of a child/young person

Would you like to tell us your name? *

YesNo

My name is: *

Would you like to tell us your parent or guardian's name? *

YesNo

My parent or guardian's name is: *

Would you like to remain anonymous during this report? *

YesNo

Parent, Guardian or Representative's Name *

Would you like the child to remain anonymous during this report? *

YesNo

Child's Name *

Questions

1) Who or what has made you feel unsafe? *(Please tell us about it here)

2) Has anything bad or strange happened to you while you did not feel safe? *(Please tell us about it here)

3) What would make you feel safe again? *(Please tell us about it here)

1) What practices have you witnessed at DFS that you believe are not in the best interests of child safety and wellbeing? *(Please describe in as much detail as possible.)

2) Please provide recommendations on how DFS could improve its child safety and wellbeing practices in the future: *(Please describe in as much detail as possible.)