HomeMy WebLinkAboutOCDSB 202 Susp Child Abuse Incid ReportOCDSB 202 Suspected Child Abuse Incident Report
Description of Report Made to Children's Aid Society (CAS)
(REFERENCES: POLICY P.090.SCO AND PROCEDURE PR.605.SCO)
DOB:
Grade/Class:
School:
Name of Student:
Parent(s)/Guardian(s):
Parent(s)/Guardian(s):
Address:
OEN:
Telephone:
Reason(s) for suspecting child abuse:
Date of Referral:
Name of person reporting to CAS (OCDSB):
Name of CAS Worker:
Date:
Date of reporting to CAS:
Were parent(s)/guardian(s) notified? Yes No
Date Print Name of
Reporting Individual
Signature of Reporting Individual
Date Print Name of Principal Signature of Principal
SEND COMPLETED FORM TO THE SUPERVISOR OF SOCIAL WORK, LEARNING SUPPORT
SERVICES ONLY. DO NOT MAINTAIN A COPY.
OCDSB 202 - SOC (OCT 2022) Page 1 of 2
IN ACCORDANCE WITH OCDSB POLICIES AND PROCEDURES,
THIS FORM MUST BE COMPLETED WITH ORIGINAL SIGNATURES.
Did CAS remove child from the school?: Yes No
Suspected Child Abuse Incident Report
(REFERENCES: POLICY P.090.SCO AND PR.605.SCO)
If the student was removed from the school by the CAS, complete as follows:
a)Date and time of removal:
Date:Time:
b)Name of child protection worker who removed the child:
Name:
c)Was a warrant or court order authorizing this apprehension produced
Yes: No:
d)Did the CAS state it had informed/would inform the parent(s)/guardian(s) of the removal?
Yes: No:
e)Date and time when CAS stated parent(s)/guardian(s) was/were informed:
Date: Time:
The personal information on this form is collected under the authority of the Child, Youth and Family Services Act, 2017 (S.O.
2017, c.14, Sched. 1). It will be used to report suspected child abuse to the Children’s Aid Society. It will be shared with those
with a need to know, including the school’s principal, social workers, psychologists, other Learning Support Staff
professionals, and the school’s resource officer. Questions or concerns should be directed to the school principal or the
District’s Freedom of Information Coordinator, Ottawa-Carleton District School Board, 133 Greenbank Road, Ottawa,
Ontario K2H 6L3, Telephone 613-596-8211. CONFIDENTIAL WHEN COMPLETED.
SEND COMPLETED FORM TO THE SUPERVISOR OF SOCIAL WORK, LEARNING SUPPORT
SERVICES ONLY. DO NOT MAINTAIN A COPY.
OCDSB 202 - SOC (OCT 2022) Page 2 of 2
IN ACCORDANCE WITH OCDSB POLICIES AND PROCEDURES,
THIS FORM MUST BE COMPLETED WITH ORIGINAL SIGNATURES.
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