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OCDSB 202 Susp Child Abuse Incid ReportSuspected Child Abuse Incident Report (REFERENCES: POLICY P.090.SCO AND PROCEDURE PR.605.SCO) School: Name of Student: DOB: Parent(s)/Guardian(s): Grade/Class: Parent(s)/Guardian(s): Address: 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 Other persons consulted: Social Worker: Psychologist: School Resource Officer: Other: Date Print Name of Reporting Individual Signature of Reporting Individual Date Print Name of Principal Signature of Principal SEND COMPLETED FORM TO COORDINATOR OF SOCIAL WORK, LEARNING SUPPORT SERVICES FOR DISTRIBUTION TO, AND REVIEW BY, THE SCHOOL SOCIAL WORKER. OCDSB 202 - SOC (May 2009) Page 1 of 2 IN ACCORDANCE WITH OCDSB POLICIES AND PROCEDURES, THIS FORM MUST BE COMPLETED WITH ORIGINAL SIGNATURES. 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 COORDINATOR OF SOCIAL WORK, LEARNING SUPPORT SERVICES FOR DISTRIBUTION TO, AND REVIEW BY, THE SCHOOL SOCIAL WORKER. OCDSB 202 - SOC (May 2009) Page 2 of 2 IN ACCORDANCE WITH OCDSB POLICIES AND PROCEDURES, THIS FORM MUST BE COMPLETED WITH ORIGINAL SIGNATURES.