Skip to main content
Search tag

Child Safe Incident Report Form

If you have a reasonable belief a child is in immediate danger, call 000.

If you would like to complete the form with assistance of one of Bayside’s Child Safe Contact Officers, please call 9599 4444.

Use this Incident Report Form to record:

  • Incidents, allegations, disclosures, or reasonable concerns in relation to abuse or neglect of a child or young person, either by staff, volunteers, contractors at Council
  • breaches or actions that contravene our policies and procedures, such as outlined in our Code of Conduct
  • you have formed a reasonable belief a child is in danger and in need of protection.

Council will determine with which authorities the report is directed to and determine whether the report falls under the Reportable Conduct Scheme.

Incident details
Include an approximate date and time. 
The person completing this report could be a Child Safe Officer, staff member, volunteer, Councillor or contractor. 
Have you contacted a Child Safe Contact Officer?
Type of incident (tick all that apply)
Details of the child/ young person affected by the incident
If known (we may need to pass the child's contact details on to the relevant authorities). 
If known
(A separate incident report form should be completed for each child involved)
Parent/care giver details
If known (we may need to get in contact with them to follow up for support or pass their details on to the relevant authorities). 
Parent/care giver contact phone
Other persons involved
Were other children and/or young people present?
Please provide details below
Has a separate incident report form been completed for this child/young person?
Has a separate incident report form been completed for this child/young person?
Has a separate incident report form been completed for this child/young person?
Has a separate incident report form been completed for this child/young person?
Has a separate incident report form been completed for this child/young person?
Alleged perpetrator details
Witness details
Were there any other witnesses to the incident?
Please provide their details below.
Details of the report
Action undertaken (if any)
Incident response (internal)
The incident reporter is the person who has seen, witnessed or observed or received the disclosure. 
Are you a staff member, volunteer, contractor, community member (with a report relating to Bayside City Council e.g. staff, volunteer, Council managed building)? 
Contact details of reporter
Incident Response (external)
Please tick who of the following have been informed of this incident
Police
Ambulance
All employees can access our EAP program