Resource File #1|
Report of Suspected Child Abuse or Maltreatment|
Texas Department of Family and Protective Services
Texas law says anyone who thinks a child or someone 65 years or older or a person with disabilities is being abused or exploited must report to DFPS in good faith and will be immune from criminal liability. Your name is kept confidential. Anyone who does not report suspected abuse can be held liable.
Two ways to report abuse
1-800-252-5400 You can call the abuse hotline 24 hours a day 7 days a week , nation wide If immediate threat if seen call 911
Or you can report the abuse with the secure website.
Texas law says anyone who thinks a child or someone 65 years or older or a person with disabilities is being abused or exploited must report to DFPS in good faith and will be immune from criminal liability. Your name is kept confidential. Anyone who does not report suspected abuse can be held liable
Our company policy
It’s are mission to ensure all children in our centers are safe and well cared for- Not only while they are at the center, but at all times. The Law requires everyone who works directly with children to report suspicions or evidence of child neglect or abuse to individual state child care licensing agencies or law enforcement agencies
Those who fail to report according to individual state child care licensing regulations can be held accountable under the law. The law prohibits interference with an individual’s attempt to report child abuse or neglect.
LDSS-2221A (Rev. 10/2008) FRONTNEW YORK STATEOFFICE OF CHILDREN AND FAMILY SERVICESREPORT OF SUSPECTEDCHILD ABUSE OR MALTREATMENT| Report Date | Case ID | Call ID | | | | |
| Time : | AM PM| Local Case # | Local Dist/Agency | SUBJECTS OF REPORT |
List all children in household, adults responsible and alleged subjects. Line # Last Name First Name Aliases| Sex (M, F, Unk)| Birthday or Age Mo/Day/ Yr| RaceCode| Ethnicity (Ck Only If Hispanic/Latino)| Relation Code| RoleCode| Lang.Code| 1. | | | | | | | | | | 2. | | | | | | | | | | 3. | | | | | | | | | | 4. | | | | | | | | | | 5. | | | | | | | | | | 6. | | | | | | | | | | 7. | | | | | | | | | | MORE
List Addresses and Telephone Numbers (Using Line Numbers From Above) | (Area Code) Telephone No. | | |
BASIS OF SUSPICIONS|
Alleged suspicions of abuse or maltreatment. Give child(ren)'s line number(s). If all children, write "ALL".| | | DOA/Fatality| | | Child's Drug/Alcohol Use| | | Swelling/Dislocation/Sprains| | | Fractures| | | Poisoning/NoxiousSubstances | | | Educational Neglect| | | Internal Injuries (e.g., Subdural Hematoma)| | | Choking/Twisting/Shaking| | | Emotional Neglect| | | Lacerations/Bruises/Welts| | | Lack of Medical Care| | | Inadequate Food/Clothing/Shelter | | | Burns/Scalding| | | Malnutrition/Failure to Thrive| | | Lack of Supervision| | | Excessive Corporal Punishment| | | Sexual Abuse| | | Abandonment| | | Inappropriate Isolation/Restraint (Institutional Abuse Only)| | | Inadequate Guardianship| | | Parent's Drug/Alcohol Misuse| | | Inappropriate Custodial Conduct (Institutional Abuse Only)| | | Other (specify)| | State reasons for suspicion, including the nature and extent of each child's injuries, abuse or maltreatment, past and present, and any evidence or suspicions of "Parental" behavior contributing to the problem. | (If known, give time/date of alleged incident) MO DAY YR Time : AM PM| Additional sheet attached with more explanation.| The Mandated Reporter Requests Finding of Investigation YES NO | CONFIDENTIAL| SOURCE(S) OF REPORT| CONFIDENTIAL|
NAME | (Area Code) TELEPHONE | NAME | (Area Code) TELEPHONE | ADDRESS | ADDRESS |
AGENCY/INSTITUTION | AGENCY/INSTITUTION | RELATIONSHIP |
| | Med. Exam/Coroner | | Physician| | Hosp. Staff| | Law Enforcement| | Neighbor| | Relative| | Instit. Staff| | | Social Services| | Public Health| | Mental Health| | School Staff| | Other (Specify)| | |
For Use By Physicians Only| Medical Diagnosis on Child | Signature of Physician who examined/treated child X| (Area Code) Telephone No. | | Hospitalization Required: None Under 1 week 1-2 weeks Over 2 weeks| Actions Taken Or| Medical Exam X-Ray Removal/Keeping Not. Med Exam/Coroner| About To Be Taken| Photographs Hospitalization Returning Home Notified DA| Signature of Person Making This Report:X | Title | Date Submitted Mo. Day Yr. |
LDSS-2221A (Rev. 10/2008) REVERSE
TO ACCESS A COPY OF THE LDSS-2221A FORM: Via Internet: http://www.ocfs.state.ny.us/main/forms/cps/ Via Intranet: http://ocfs.state.nyenet/admin/forms/SCR/ OR
TO ORDER A SUPPLY OF FORMS ACCESS FORM (OCFS-4627) Request for Forms and Publications, from either site above, fill it out and send to: Office of Children and Family Services, Resource Distribution Center, 11 Fourth Ave, Rensselaer, NY 12144. -------------------------------------------------
If you have difficulty accessing this form from either site, you can call The Forms Hot Line at 518-473-0971. Leave a detailed message including your name, address, city, state, the form number you need, the quantity and a phone number in case we need to contact you. NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES
RACE CODE| ETHNICITYCODE| RELATION CODES FAMILIAL REPORTS(Choose One)| ROLE CODE(Choose One)| LANGUAGE CODE(Choose One)| AA: Black or African-American| (Check Only If Hispanic/ Latino)| AU: Aunt/Uncle | XX: Other | AB: Abused Child | CH: Chinese | KR: Korean | AL: Alaskan Native | | CH: Child | PA: Parent | MA: Maltreated Child| CR: Creole | MU: Multiple | AS: Asian| | GP: Grandparent | PS: Parent Substitute| AS: Alleged Subject (Perpetrator)| EN: English | PL: Polish| NA: Native American| | FM: Other Family Member | UH: Unrelated Home Member | | FR: French | RS: Russian| PI: Native Hawaiian/Pacific Islander | | FP: Foster Parent | UK: Unknown | NO: No Role | GR: German | SI: Sign | WH: White | | DC: Daycare Provider| | UK: Unknown| HI: Hindi | SP: Spanish| XX: Other| | IAB REPORTS ONLY| | HW: Hebrew | VT: Vietnamese| UNK: Unknown| | AR: Administrator | IN: Instit. Non-Prof | | IT: Italian | XX: Other| | | CW: Child Care Worker| IP: Instit. Pers/Vol. | | JP: Japanese| | | | DO: Director/Operator | PI: Psychiatric Staff | | | | Abstract of Sections from Article 6, Title 6, Social Services Law Section 412. Definitions
1. Definition of Child Abuse, (see also N.Y.S. Family Court Act Section 1012(e)) An “abused child” is a child less than eighteen years of age whose parent or other person legally responsible for his care: 1) Inflicts or allows to be inflicted upon the child serious physical injury, or 2) Creates or allows to be created a substantial risk of physical injury, or 3) Commits sexual abuse against the child or allows sexual abuse to be committed. 2. Definition of Child Maltreatment, (see also N.Y.S. Family Court Act, Section 1012(f))
A “maltreated child” is a child under eighteen years of age whose physical, mental or emotional condition has been impaired or is in imminent danger of becoming impaired as a result of the failure of his parent or other person legally responsible for his care to exercise a minimum degree of care: 1) in supplying the child with adequate food, clothing, shelter, education, medical or surgical care, though financially able to do so or offered financial or other reasonable means to do so; or 1) in providing the child with proper supervision or guardianship; or 1) by unreasonably inflicting, or allowing to be inflicted, harm or a substantial risk thereof, including the infliction of excessive
corporal punishment; or
4) by misusing a drug or drugs; or
4) by misusing alcoholic beverages to the extent that he loses self-control of his actions; or 5) by any other acts of a similarly serious nature requiring the aid of the Family Court; or 6) By abandoning the child.
Section 415. Reporting Procedure. Reports of suspected child abuse or maltreatment shall be made immediately by telephone and in writing within 48 hours after such oral report. -------------------------------------------------
Submit the written paper copy of the LDSS-2221A form originally signed to: the County Department of Social Services (DSS) where the abused/maltreated child resides. To locate your local DSS, visit this site http://www.ocfs.state.ny.us/main/localdss.asp.
Residential Institutional Abuse Reports: Submit a paper copy of form, LDSS 2221A, originally signed. It must be submitted directly to the Office of Children and Family Services (OCFS) Regional Office, associated with the county in which the abused/maltreated child is in care.
NYS CHILD ABUSE AND MALTREATMENT REGISTER: 1-800-635-1522 (FOR MANDATED REPORTERS ONLY) -------------------------------------------------
1-800-342-3720 (FOR PUBLIC CALLERS) Section 419. Immunity from Liability, Pursuant to Section 419 of the Social Services Law, any person, official, or institution participating in good faith in the making of a report of suspected child abuse or maltreatment, the taking of photographs, or the removal or keeping of a child pursuant to the relevant provisions of the Social Services Law shall have immunity from any liability, civil or criminal, that might otherwise result by reason of such actions. For the purpose of any proceeding, civil or criminal, the good faith of any such person, official, or institution required to report cases of child abuse or maltreatment shall be presumed, provided such person, official or institution was acting in discharge of their duties and within the scope of their employment, and that such liability did not result from the willful misconduct or gross negligence of such person, official or institution. Section 420. Penalties for Failure to Report.
1. Any person, official, or institution required by this title to report a case of suspected child abuse or maltreatment who willfully fails to do so shall be guilty of a class A misdemeanor. 1. Any person, official, or institution required by this title to report a case of suspected child abuse or maltreatment who knowingly and willfully fails to do so shall be civilly liable for the damages proximately caused by such failure. LDSS-2221A (Rev. 10/2008) ATTACHMENT
STAPLE TO LDSS-2221A (IF NEEDED)
REPORT OF SUSPECTED
CHILD ABUSE OR MALTREATMENT
(Use only if the space on the LDSS-2221A under “Reasons for Suspicion” is not enough to accommodate your information) Report Date | Case ID | Call ID | Time : | AM PM| Local Case # | Local Dist/Agency | PERSON MAKING THIS REPORT:| |
Print clearly if filling out hard copy. |
Continued: State reasons for suspicion, including the nature and extent of each child's injuries, abuse or maltreatment, past and present, and any evidence or suspicions of "Parental" behavior contributing to the problem. | (If known, give time/date of alleged incident) MO DAY YR Time : AM PM|