Safe Ministry Concerns Record

Please use this form to report any concerns you have with any persons at Dayboro Church. This form submission is handled confidentially within the Senior Pastors and our Safer Churches Representative.

Your Details

First Name

Last Name

Mobile Number

Email Address

Name of the person about whom you have a concern

Reporter's relationship to the person about whom you are concerned

Age of person about whom you have a concern

Describe your concerns, what was observed or what was said.

It is important to provide as much information as possible, basing your information on facts and observations, without making assumptions or jumping to conclusions or making “value” judgments. If a disclosure has been made, a verbatim (word for word) account must be written of the disclosure to the best of the reporter’s ability, as soon after the disclosure as is practical. Please email any photos and attachments to dayborochurch@gmail.com .

Concern

Time and date of the incident or recording

Date

Time

The Safe Ministry Framework is developed and owned by SMR Pty Ltd. This document cannot be modified without express written permission through a licence agreement. Please contact SMR Pty Ltd at email info@safercommunities.net.au to seek permission.
SMR can also provide customisation of the Safe Ministry Framework for your church or denomination.

Disclaimer: This publication is not legal advice. The ideas and procedures herein are based on nationally recognised good practice advice for Safe Ministry and have been written with due regard to Australian legislation March 2020. Legal advice may need to be sought when responding to individual incidents.