Complaints and allegations record form

Your Name*

First Last

Position*

Name of the child or young person involved*

First Last

Name of person making complaint*

First Last

Your Mobile Phone*

Your Email*

Name of person who the complaint was made against*

First Last

1. Nature of the complaint*

Include time, date, location, what happened and who was involved (this can include observations of the child’s behaviour

2. Details of any injuries and if the child received medical attention*

3. Accurately record what the child said 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*

In the case of an allegation of abuse, formal investigations and interviews will be carried out by DCJ and/or NSW Police. You must record what the child has said but unless it is your role to investigate, you should not interview the child

4. Details of anyone who saw what happened*

5. Does this complaint indicate the possibility of child abuse, such as physical abuse, psychological or emotional abuse, sexual abuse or neglect?*

Yes
No

6. Who did you make a report to?*

NSW Police
DCJ via ChildStory
DCJ via 132 111
OCG Reportable Conduct Directorate
Internal reporting obligations (name the relevant department or person)
Other (name them below)

6. Who did you make a report to?*

If you selected "Other", name the organisation

7. People spoken to in relation to the matter

Describe who was spoken to and why they were spoken to about the matter – include police officers, DCJ staff, OCG staff and anyone else you spoke to

Email

This field is for validation purposes and should be left unchanged.