Suspected abuse or exploitation of a child or vulnerable young person 1. The Author 2. Injured 3. Educator / Guardian / Relative 4. Details of the incident Does the Reporter wish to be identified? YesNo In case of a positive answer, the name and contact information of the author: Name last name: Tel. Number (optional): (alternative): E-mail: Name of the organization: Position: Is the victim a child or an adult? ChildAdult Name of the victim: Name last name: Nickname: Unknown (If you do not know the victim's name, mark unknown.) Estimated age: Gender: A child is a person under 18 years of age Provide us with any additional information: Identity: Name last name: Unknown (If you do not know the name of the educator / guardian / relative, mark unknown.) Actual address: (example includes: village name, street name, city, house, building) Tel. Number (optional): (alternative): E-mail: Estimated age: Gender: Incident Type (check all): Sexual abuse (eg fondling, kissing, non-contact sexual activity, rape)Exploitation (eg sex trafficking, forced prostitution, sex for subsistence, child labour)Emotional abuse (eg bullying, threats, humiliation, bullying)Physical abuse (eg hitting, kicking, shaking)Other (specify other) Location (examples include: village name, street name, city, house, building) Address / physical location of the incident: Estimated date of incident: Notification date: Physical and emotional condition of the victim (check all) Cuts, bruises, bruises, scratchesBehavioral changes (eg, anger, crying, emotional outbursts, depression, sudden illness)Other Please describe the physical and emotional state of the victim: Identity: Name last name: Unknown (If you cannot name the suspect, mark unknown.) E-mail: Estimated age: Gender: Actual address of the suspect: (example includes: village name, street name, city, house, building) Name of the organization: Position: Previous Next Send
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