Form Contents

Required fields are marked with an asterisk (*).

1. Report details

Your name and contact details

Name of child/young person involved

Child/young person's contact details

Name of the child/young person's authorised adult

Contact details of the child/young person's authorised adult

Name of person who the concern / report is made against

Contact details for the person who the concern / report is made against

2. Complaint details (*)

Nature of the complaint: include time, date, location, what happened and who was involved (this can include observations of the child or young person’s behaviour). *

3. Injuries and medical treatment (*)

Enter the details of any injuries and if the child received medical attention. *

4. Child or young person's description of what happened

What did the child or young person say when describing what happened – use their exact words – or record why you suspect abuse due to an indirect disclosure, such as a drawing or observed behaviour

5. Witness details

Details of anyone who saw what happened. Please include their name and contact details.

6. Reported to anyone else

Have you made a report to anyone else?

NSW Police
DCJ via ChildStory
DCJ via 132 111
OCG Reportable Conduct Directorate
Internally (name the person and department below)
Other (name the person and department below)

7. Who else have you spoken to?

Have you spoken to anyone else in relation to this matter (describe who was spoken to and why they were spoken to about the matter)

8. Further information

Is there anything else you feel is important to provide for this complaint/report?

9. Upload files

Please upload any files you believe are relevant