Form 325-1

Report Regarding Suspected Abuse/Neglect

1. Alleged

Psychological Neglect:
Physical Abuse:
Criminal Harrasment Abuse:
Emotional Abuse:
Sexual Abuse:
Other (i.e. Prostitution or Substance Abuse):

2. Specific Concerns and Observations:

3. Information

4. Reporting
Child Youth and Family Enhancement Act Section 4(1) states "any person who has reasonable and probable grounds to believe that a child is in need of intervention shall forthwith report the matter to a Director"

Principal's Signature:

7.   Attach notes summarizing subsequent contacts and disposition if known.
This form and documentation is to be kept in a separate confidential file by the School Administrator