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Page 16 of 17 Appendix 2 - Recording allegations or suspicions of child abuse - Action Checklist Date ........................ Location ................................ Name of child .................................... Age ................................ Parent's name ................................... Phone ................................ Home address .................................................................................... ......................................................................................................... Is the person making the report expressing their own concerns or passing on those of somebody else? ......................................................................................................... What has prompted the concerns? Include dates, times etc. of any specific incidents ......................................................................................................... ......................................................................................................... ......................................................................................................... Any physical signs? Behavioural signs? Indirect signs? ......................................................................................................... ......................................................................................................... Has the child been spoken to? If so, what was said? ......................................................................................................... Has anybody been alleged to be the abuser? If so, record details. ......................................................................................................... Have the parents been contacted? If so what was said? ......................................................................................................... Has anyone else been consulted? If so, record details. .........................................................................................................
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