• All staff and child care workers are responsible to report any disclosures or possible evidence of harm to a child. These reports must be submitted to the Child Protection Response Team (CPRT) at [email protected] within 24 hours of filling out the known data. The report should be submitted using this form, which can also be accessed online at Cadence.org/ReportHarm. Please report only the information that is known at the time the allegation was received without interviewing the child(ren) harmed or alleged perpetrator(s). Not all blanks need to be filled in order to submit this form. The CPRT will be in contact with you and appropriate staff to guide the response. If you have not received acknowledgement from a CPRT member within 36 hours, please resubmit.
  • Person Making Report (The person with information pertaining to the incident)

  • Date Format: MM slash DD slash YYYY
  • :
  • Child Harmed

  • Alleged Perpetrator

  • Incident Report

  • Was the reported information volunteered? What prompted the report? Was there suspicion of harm? What led to the suspicion of harm/abuse/neglect/inappropriate behavior? Who was present for the report?
  • Include: Dates, Frequency, Places. What happened? (Quote exactly the words spoken as much as possible.)
  • List names, relationship to child harmed, and phone.
  • Classmates, siblings, friends, adults, others present at the same event, etc.
  • Such as contact government, law enforcement, or child protective service agencies, create safety plan, etc.
  • Person Filing Report (If different from the person making the report)