You are here:HomeAbout UsWhat We ValueChild Safety at CFAChild Safety Reporting Form Your Information Your Name Your role/position at CFA (if applicable) Your connection with the child or young person Please add either phone or email so you can be contacted Your best contact phone number Your email address Complete if you are usually located at a District Office or Brigade Region District Brigade About the complaint, allegation, incident or concern I am reporting: a disclosure, complaint or allegation of child abuse or harm a disclosure, complaint or allegation of inappropriate conduct or comments towards, or in the presence of a child a disclosure, complaint or allegation of inappropriate conduct or comments towards others by a child or young person an identified issue, action or behaviour that may increase the risk of child abuse or physical harm to a child or young person Date that you became aware of the disclosure, complaint, allegation, incident or concern An incident may involve one or many types of harm. Harm can occur because of an action that is 'against, with or in the presence of a child'. Please select all harm types that relate to this incident. Details of alleged incident Physical abuse eg. physical violence of assault Emotional abuse eg. threats, bullying (including cyberbullying), hazing, humiliation, sexist or racist language directed at a child Sexual abuse or misconduct (including grooming behaviour) in person or online Neglect of a child eg. failure to supervise Information or a reasonable belief that an adult may pose a risk of harm to children and young people Cumulative events such as small incidents, related to a child or young person which when viewed together may result in a level of harm to children or young people Safety, wellbeing, and/or mental health concerns (e.g. child or young person attempting suicide, talking about suicide, or demonstrating self-harm behaviours Other Other Please add the relevant details Where did the alleged conduct occur? During a CFA activity Outside a CFA event or activity Unknown Please describe the alleged incident Please provide names and contact phone numbers for anyone who may have witnessed the alleged incident, or who may have information about the alleged incident Child or young person involved in the incident Name of the child or young person What is the affiliation of the child or young person with CFA? Junior member 16 and 17 -year-old Senior Member Apprentices, trainees and members of staff aged under 18 Children and young people participating in CFA activities and events Adult who report historic abuse that occurred when they were under 18 years of age They are not a CFA member Gender of the child or young person Female Male Other Date of birth of the child or young person if known It is not always appropriate to inform a parent or guardian. Examples include when the allegation of harm is being made against a parent or caregiver of a young person, or if you are worried about how the parent or caregiver will respond to the allegation (i.e., threatening behaviour, violence). Please contact the Child Safety Team for advice and information Is the alleged victim/parent/guardian aware of the complaint, concern or allegation? Yes No Contact Information if known Address Town / Suburb Postcode Telephone number of the child or young person Email address of the child or young person Name of the parent/guardian Telephone number of the parent/guardian Email of the parent/guardian Any other relevant information about the child or young person (and/or their parent/guardian) Example: “Jessica has ADHD and may need additional support” or “Mrs Ibraham is Arabic speaking and will require an interpreter.” About the subject of the allegation This section applies to reports where there are concerns that a person is alleged to have acted inappropriately towards a child or young person. Name of the individual who is the subject of the allegation? Gender of the subject of the allegation? Female Male Other What connection does the subject of allegation have to CFA Junior Leader Junior Member (aged 11-15) Senior Member (aged 16-17) Senior Member (aged 18+) FRV Secondee CFA Employee Unknown/Other Not a CFA Member Please describe your connection to the subject of the allegation Example: we are members of the same Brigade Relationship of the subject of the allegation to the child or young person Example: “John is the 2nd Lt and Lesley is a Junior Member at my Brigade”. Any other relevant information about the subject of the allegation Example: “Jessica has ADHD and may need additional support”. Contact information of the subject of the allegation if known Telephone Email address It is not always appropriate to inform a parent or guardian. Examples include when the allegation of harm is being made against a parent or caregiver of a young person, or if you are worried about how the parent or caregiver will respond to the allegation (i.e., threatening behaviour, violence). Please contact the Child Safety Team for advice and information Is the alleged victim/parent/guardian aware of the complaint, concern or allegation? Yes No Name of the parent/guardian Telephone number of the parent/guardian Email of the parent/guardian Reporting to authorities Has this matter been reported to Victoria Police? Yes No I am not sure if the police need to be contacted Not applicable Has this matter been reported to DFFH Child Protection? Yes No I am not sure if Child Protection need to be contacted Not applicable CFA’s Child Safety Officer is collecting information about child safety related concerns, complaints and allegations, including personal information and health information for the purpose of ensuring CFA meets its obligations under the Child Wellbeing and Safety Act 2014, Family Violence Protection Act 2005, and the Crimes Act 1958 (Crimes Act). CFA may use this information to fulfil its legislative obligations in relation to: investigating matters of concern, complaints or allegations contacting you to clarify or seek further information contained within the form reporting matters to external authorities to fulfil our legal obligations supporting the obligations of the Authority in relation to risk management. It is crucial under the Crimes Act that people report any concerns about a child’s safety, as a failure to report concerns may result in criminal action. Further, CFA requires all members to report matters relating to health and safety of a child, and failure to do so may result in disciplinary action. Once submitted, CFA has obligations to act in relation to the information provided. Amendments to this information may be made at any time by contacting the Child Safety Officer: childsafetyofficer@cfa.vic.gov.au Page last updated: Monday, 21 February 2022 2:19:49 PM