Leisure City Child Safety Concern Report

Child Safety Concern Reporting Form
A Child Safety Concern (CSC) refers to any situation, behaviour, communication, or observation, whether witnessed, disclosed, or suspected, that may indicate a child or young person is at risk of harm, abuse, neglect, or exploitation. This includes physical, emotional, or sexual abuse and grooming.

This form must be submitted within 24 hours of identifying a CSC. Form submissions are only received by the Director Leisure City. The Director will inform other members of the management team as required for the investigation.
Which category best describes your association with the Leisure City?*
Leisure City is a group of businesses which includes Melbourne Swimming Club (squad) and Melbourne Swimming Academy (learn-to-swim)
Date of Report*

DayMonthYear

Hour MinutesAM/PM Option
Desired Form*
Person Completing This Form
Would you like to leave your details?*
Full Name*

First NameLast Name
Mobile*
Email*
Position*
If you work in multiple roles across the business, please select your primary position

Child Safety Concern (CSC) Details
When was the CSC first identified?*

DayMonthYear
Date
Hour MinutesAM/PM Option
Location*
Location (Other)*
Select the detail(s) you know*

Child's NameName of Child's Parent/GuardianEmail of Child's Parent/GuardianMobile of Child's Parent/GuardianNone
Check
Error: If 'none' is selected, no other values may be selected.
Child's Name*

First NameLast Name
Name of Child's Parent/Guardian*

First NameLast Name
Email of Child's Parent/Guardian*
Mobile of Child's Parent/Guardian*

Child Safety Concern (CSC) Summary
Please describe your concerns*
Please describe the immediate actions taken (if any)*
E.g. contacted/spoke with parent, what was said, etc
Additional information*
Type 'none' if N/A

Child Safety Concern (CSC) Outcome Report
Summary of the CSC*
Assessment against Policies*
Please consider: 1. Whether there was a breach of internal policies (e.g. Code of Conduct/child safety standards. 2. Whether there were any mitigating or aggravating factors.
Outcome and Actions Taken*
Please detail: 1. Final determination (whether CSC was substantiated, partially substantiated, unsubstantiated). 2. What actions were taken (e.g. reporting to authorities/preventative action). 3. Whether further action or monitoring is required.
Communication Summary*
Please detail: 1. How and when the outcome was communicated to the relevant parties. 2. What information was provided. 3. Any communication with other parties (e.g. involved staff, parents, school).
Learnings & Suggestions*
Please detail: 1. Any broader lessons identified. 2. Suggestions for process, training, or policy changes to prevent recurrence. 3. Whether this issue should be discussed at staff meetings or leadership reviews

Child Safety Concern Reporting Form