Suspected abuse or exploitation of a child or vulnerable adult

Any suspicion or concern of abuse or exploitation of a child or adult involving Caritas staff[1] and collaborators[2 ] must be reported as required by the Caritas Africa Complaints Policy and Procedure and the Safeguarding Children and Vulnerable Adults Policy. If you can’t fill in all the sections, please indicate what you know. If there is more than one victim, please complete a separate report for each victim. The identity of the reporter will only be disclosed on a “need to know” basis. If you, the reporter, believe that there is imminent danger to yourself or anyone else involved, you should immediately notify the Secretary General of Caritas Africa. Caritas Africa is committed to processing and responding to all reports.

If there is an immediate threat to life or if emergency assistance is needed, please contact your authorities and alert local senior management immediately. The purpose of this Report Form is to bring any suspected abusive or exploitative activity to the attention of Caritas Africa for evaluation and action.

REPORTED BY: Does the reporter wish to be identified?
If yes, name and contact details of rapporteur: First name
Last name of reporter
Reporter’s (Main) telephone number (Include area code or country code)
Rapporteur’s e-mail
Name of reporting organization
Rapporteur’s job title
VICTIM: Is the victim a child or an adult*?
Victim’s identity. First name of victim *:
Last name of victim *:
(If you are unable to provide information about the victim’s identity, check the “Identity unknown” box).

Victim’s approximate age: (The term “child” refers to anyone under the age of 18).
Sex of victim :
Enter any additional information here. Caregiver/Parent* :
(If you cannot provide information on the identity of the caregiver/caretaker/dependent relative,
check the “Identity unknown” box).

Physical address of Caregiver/Parent*: (e.g. village name, street name, town, house, building)
Telephone number (Include area code or country code) (Main) of Caregiver/Parent* :
Caregiver’s/Parent’s e-mail address
Approximate age of Caregiver/Guardian/Parent*.
Gender of Caregiver/Parent* :
INCIDENT DETAILS Type of incident *: (Check all that apply)

Incident location. Address/Physical location of incident (e.g. village name, street name, town, house, building)
Country Incident location * :
Approximate date of incident :
Date of incident report * :
Physical and emotional state. Victim’s physical and emotional state (Check all that apply)

Please describe in detail the victim’s physical and emotional condition*.
Impairment or disability: Does the victim have a physical impairment or disability*?
If yes, describe the impairment or disability.
Circumstances of knowledge of the incident *:
To be defined
Victim’s safety: Was the victim in immediate danger before this form was completed?
Have the relevant authorities and senior management been contacted (if applicable)?
Please enter any additional information here.
SUSPECT. First and last name of suspect *
Identity unknown (If you can’t provide any information about the suspect’s identity, check the “Identity unknown” box.
Unknown” box).

Suspect’s (Main) telephone number (Include area code or country code)
Suspect’s e-mail address
Approximate age of suspect :
Sex of suspect :
Physical description of suspect:
Suspect’s physical address (e.g. village name, street name, town, house, building)
Name of suspect organization :
Suspect’s job title :
ADDITIONAL INFORMATION: Do others have additional information *?
If yes, please give details:
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[1] Staff includes staff, volunteers, interns and governance members.

[2] Collaborators refer to consultants and contractors.