REPORTED TYPES OF ABUSE(Check All That Apply)
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What happened today that led you to make this report? (Observations, beliefs, statements made by victim) (2000 characters max)
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Does the Suspected Abuser still have access to the victim?
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If Yes, explain. Provide any known time frame (2 days, 1 week, ongoing etc.) (500 characters max)
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If the Alleged Victim is under 60, please describe their cognitive and/or physical limitations.
(Do they need a caregiver to meet their basic daily needs? Are they wheelchair dependent?
What current third party assistance are you aware of for this person?) (500 characters max)
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Is there a potential danger to the investigating worker, or other problem with access? (guns, animals, recent violence etc.)
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If yes please specify: (500 characters max)
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OTHER PERSONS BELIEVED TO HAVE KNOWLEDGE OF ABUSE FAMILY MEMBER OR OTHER
PERSON RESPONSIBLE FOR VICTIM'S CARE. (If unknown, list contact person)
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WRITTEN REPORT (Enter information about the agencies receiving this report.
Not required if only reporting to APS.)
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