• Safeguarding Children and Young People Incident Report

    Adult Reporting Form

  • If you have concerns about the safety or welfare of a child or young person who is involved with Aikido Victoria (Aiki-Kai) Inc in any way, please complete the form below.

    A Safeguarding Children and Young People Incident Report form is required for all incidents.

    Reportable incident(s) could be related to: 

    • Children and young people participating in Aikido Victoria activities and events
    • Adults who report historic abuse that occurred whilst they were aged under 18 

     

    What to report to Aikido Victoria:

    You should report any concerns about the safety of a child, young person or a group of such that relate to:

    • A disclosure, complaint or allegation of child abuse or harm
    • A disclosure, complaint or allegation of inappropriate conduct or comments towards, or in the presence of a child or young person
    • A disclosure, complaint or allegation of inappropriate conduct or comments towards others by a child or young person
    • An identified risk, or actions and behaviours that increase the risk of child abuse 
    • Concerns about the mental health or wellbeing of a child or young person
    • Concerns about the physical safety of a child or young person

    Please provide as much detail as you can. If you do not have access to some of the information asked in the reporting form, that is okay. It is important that you still make a report to Aikido Victoria. Reports are managed in line with Aikido Victoria’s Reporting of Child Safety Process(ie.PPT Flowchart).

     

    When to report to Aikido Victoria:

    It is important that you report your concerns to Aikido Victoria and if necessary, the authorities, as soon as practicable.

    If you believe a child is in immediate danger, call 000. 

    If a child has been abused or is at immediate risk of harm, you must take reasonable steps to protect them. 

    After contacting 000, if your child safety concern requires further immediate attention and support, please contact: 

    Child Protection 24/7 Line
    Phone: 13 12 78  

    Commission for Children and Young People (CCYP)
    Phone: 1300 782 978
    or (03) 8601 5281
    Email: contact@ccyp.vic.gov.au   


    Please note that all the questions in the form are optional and do not have to be answered if you do not feel safe to do so. It should be noted however that limited information can compromise Aikido Victoria’s ability to investigate child safety concerns.

  • Your information

  •  -
  • Which option best describes your relationship with Aikido Victoria*

  • Information about the incident and the person you believe has harmed a child or young person

  • As far as you know, have you or another person already reported this issue to Aikido Victoria?*
  • As far as you know, have you or another person already contacted or reported to the police about this issue?*
  • As far as you know, have you or another person already contacted or reported to Commission for Children and Young People (CCYP) about this issue?
  • As far as you know, what is their gender?*
  • What is their relationship to Aikido Victoria? (Select all that apply)*

  • Information about the child or young person/people who are affected

  • Please provide information about the child or young person/people who are affected. Leave blank if unknown.
  • What are the date(s) of the issue(s) you are reporting? (ie. when did it happen?)

  • Aikido Victoria’s Child Safety team maintains information on child safety related concerns, complaints, and allegations, including personal information and health information for the purpose of ensuring Aikido Victoria meets its obligations under the Child Wellbeing and Safety Act 2014, Family Violence Protection Act 2005, and the Crimes Act 1958 (Crimes Act). Aikido Victoria may use this information to fulfil its legislative obligations in relation to: 

    • Investigating matters of concern, complaints, or allegations
    • Contacting you to clarify or seek further information contained within the form 
    • Reporting matters to external authorities to fulfil our legal obligations
    • Supporting the obligations of the Authority in relation to risk management.

    Under the Crimes Act, it is important that people report any concerns about a child’s safety. Failure to report concerns may result in criminal action. Further, Aikido Victoria requires all members to report matters relating to health and safety of children and young people, and failure to do so may result in disciplinary action. Once submitted, Aikido Victoria has obligations to act in relation to the information provided. 

    Amendments to this information may be made at any time by contacting the Child Safety Officer: childsafe@aikidomelbourne.org.au

  • Date*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Should be Empty: