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Suspected Child Abuse Reporting SS 8572 Mobile App

The Suspected Child Abuse Reporting Form SS 8572 mobile app is to be completed by mandated child abuse reporters using a smartphone or tablet to fill out and submit. The app documents reporting party details, report notification, victim, involved parties and incident information for the purposes of law enforcement at the sheriff department, as well as child services. As a social worker who is a mandated child abuse reporter, use this child abuse report form on behalf of the patient and/or patient family to document sexual abuse or child abuse neglect in a child abuse report designed for legal use by authorities and child protective services.

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  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Suspected Child Abuse Reporting SS 8572 Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    To Be Completed by Mandated Child Abuse Reporters Pursuant to Penal Code Section 11166

  • Ico textbox

    CASE NAME:

  • Ico textbox

    CASE NUMBER:

  • Ico textbox

    NAME OF MANDATED REPORTER

  • Ico textbox

    TITLE

  • Ico textbox

    MANDATED REPORTER CATEGORY

  • Ico textbox

    REPORTER'S BUSINESS/AGENCY NAME AND ADDRESS

  • Ico textbox

    Street

  • Ico textbox

    City

  • Ico integer

    Zip

  • Ico dropdown

    DID MANDATED REPORTER WITNESS THE INCIDENT?

  • Ico textbox

    REPORTER'S TELEPHONE (DAYTIME)

  • Ico signature

    SIGNATURE

  • Ico date

    TODAY'S DATE

  • Ico checkbox

    LAW ENFORCEMENT

  • Ico checkbox

    COUNTY PROBATION

  • Ico checkbox

    COUNTY WELFARE / CPS (Child Protective Services)

  • Ico textbox

    AGENCY

  • Ico textbox

    ADDRESS Street

  • Ico textbox

    City

  • Ico integer

    Zip

  • Ico date

    DATE

  • Ico time

    TIME OF PHONE CALL

  • Ico textbox

    OFFICIAL CONTACTED - TITLE

  • Ico textbox

    TELEPHONE

  • Ico statictext

    One report per victim

  • Ico textbox

    NAME (LAST, FIRST, MIDDLE)

  • Ico date

    BIRTHDATE

  • ...and More!

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