Office for Safeguarding Services

Online Safeguarding Incident Report

Page 1 of 8

Person making this report

Prefer to remain anonymous

First Name *

Family Name *

Address

Phone

Email Address

Other contacts

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 2 of 8

What is the nature of the concern or incident you are reporting? *

Other concerning behaviour (please specify) *

IMPORTANT - Does this matter involve a suspected child sexual offence (i.e. against a person who is or was under 18 years) now or in the past? *

NOTE - A sexual offence may include, for example, grooming a child for sexual activity (including online), sexual fondling or touching, sexual intercourse, making or sharing child pornography or sexual videos or photos of children.

YesNo

If 'Yes', has a report been made to the police or other relevant government agency (e.g. Child Safety Services)? *

YesNoUnknown

Which government agency was the report made to? *

PoliceOther Government Agency

Name of Government Agency *

Date of report (if known)

Report Number (if known)

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 3 of 8

Who is the person mistreated/abused? *

Known (details to be provided below)UnknownNot Applicable

First Name

Family Name

Gender *

MaleFemaleUnknown/Undisclosed

Age at the time of the incident *

AdultChild (under 18 years)Unknown

Address (if known)

Phone (if known)

Email (if known)

Other contacts (if known)

If 'Other', please specify *

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 4 of 8

Who is the alleged offender/perpetrator/person of concern? *

Known (details to be provided below)UnknownNot Applicable

First Name

Family Name

Gender *

MaleFemaleUnknown/Undisclosed

Age at the time of the incident *

AdultChild (under 18 years)Unknown

Address (if known)

Phone (if known)

Email (if known)

Other contacts (if known)

If 'Other', please specify *

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 5 of 8

What are the details of the incident?

Time of the incident (if known)

Date/s (if known or approximates)

Location/s (if known)

Please describe the events/what happened in as much detail as possible *

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 6 of 8

Witnesses

Did you personally observe the incident/s? *

YesNo

If 'No' how did you come to know about the incident/s? *

Did anyone else witness the incident/s? *

YesNoUnknown

If 'Yes' please provide their name/s and contact details *

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 7 of 8

Supporting Items

Do you have any items that might support this report? (e.g. photos, videos, screen shots, messages, letters, reports, records) *

YesNo

If 'Yes' please specify and attach (below) *

Attachments

Browse

Office for Safeguarding Services

Online Safeguarding Incident Report

Page 8 of 8

Declaration

I make this report in good faith. *

I understand that the Archdiocese of Brisbane strongly encourages all suspected criminal behaviour to be reported directly to the Police. *

I understand that in Queensland, it is a criminal offence to fail to report a suspected child sexual offence (past or present) to the police, unless there is a reasonable excuse not to. *

PRIVACY

Generally, the Archdiocese of Brisbane collects, uses and holds personal information if it is reasonably necessary for or directly related to the performance of Archdiocesan functions and activities. This may include for the purpose of fulfilling Archdiocesan mission and directions, facilitating internal business operations and complying with legal or regulatory requirements. Generally, the Archdiocese only uses or discloses personal information for the purposes for which it was collected (as set out above). Except as otherwise permitted by law, the Archdiocese only collects and discloses sensitive information where consent is provided and if the information is reasonably necessary for the performance of our functions and activities (set out above).