SUSPECTED CHILD ABUSE REPORT

Completing the Form

1. The report will be filled in online and an Adobe PDF document will be created with your answers will be created and submitted for you.

2. Enter the number of victims. You will have the option to enter the number of victims inside the form in Section E.

3. It is important to indicate whether or not the child is developmentally delayed or has some disability.

4. The mandated reporter must complete and submit the SCAR (SS8572), even if some of the requested information is "unknown"; please complete all fields on the form. If the information is unknown, enter "unknown".

Completing the Narrative 

The SCAR requires that you provide the date, time, and the place of the incident. Additionally, you are required to include the following in your narrative description:
1. What the victim(s) said;

2. What the mandated reporter (you) observed;

3. What the person accompanying the victim(s) said; and

4. Similar past incidents involving the victim(s) or suspect.

Review the questions below before completing the narrative. By providing the information requested, you will assist the Child’s Social Worker and law enforcement official assigned to investigate the allegations you have reported. If you don’t have all the information, do your best to include as much information as possible. Keep these questions in mind when making your next report:

1. The names of the victim(s) and the perpetrator(s)/suspect(s). Include the relationship of the perpetrator(s)/suspect(s) to the victim and the address and/or current location.

2. Is the victim developmentally disabled?

3. Does the victim have any disability?

4. Provide any known details.

5. Provide specific dates and/or timeframes.

6. Provide the specific location (address if known) of the incident.

7. Who, if anyone, was a witness to the event?

8. Is there anyone else who may know about the incident or who may be able to provide information about the victim or the victim’s family?

9. Provide the identifying information (name, address, telephone, etc.) and relationship of the person to the victim/family.

DEFINITIONS AND GENERAL INSTRUCTIONS FOR COMPLETION OF FORM BCIA 8572

All Penal Code (PC) references are located in Article 2.5 of the California PC. This article is known as the Child Abuse and Neglect Reporting Act (CANRA). The provisions of CANRA may be viewed at: http://leginfo.legislature.ca.gov/faces/codes.xhtml (specify "Penal Code" and search for sections 11164-11174.3). A mandated reporter must complete and submit form BCIA 8572 even if some of the requested information is not known. (PC section 11167(a).)

I. MANDATED CHILD ABUSE REPORTERS
Mandated child abuse reporters include all those individuals and entities listed in PC section 11165.7.

II. TO WHOM REPORTS ARE TO BE MADE ("DESIGNATED AGENCIES")
Reports of suspected child abuse or neglect shall be made by mandated reporters to any police department or sheriff's department (not including a school district police or security department), the county probation department (if designated by the county to receive mandated reports), or the county welfare department. (PC section 11165.9.)

III. REPORTING RESPONSIBILITIES
Any mandated reporter who has knowledge of or observes a child, in his or her professional capacity or within the scope of his or her employment, whom he or she knows or reasonably suspects has been the victim of child abuse or neglect shall report such suspected incident of abuse or neglect to a designated agency immediately or as soon as practically possible by telephone and shall prepare and send a written report thereof within 36 hours of receiving the information concerning the incident. (PC section 11166(a).)

No mandated reporter who reports a suspected incident of child abuse or neglect shall be held civilly or criminally liable for any report required or authorized by CANRA. Any other person reporting a known or suspected incident of child abuse or neglect shall not incur civil or criminal liability as a result of any report authorized by CANRA unless it can be proven the report was false and the person knew it was false or made the report with reckless disregard of its truth or falsity. (PC section 11172(a).)

IV. INSTRUCTIONS
SECTION A – REPORTING PARTY: Enter the mandated reporter's name, title, category (from PC section 11165.7), business/agency name and address, daytime telephone number, and today's date. Check yes/no whether the mandated reporter witnessed the incident. The signature area is for either the mandated reporter or, if the report is telephoned in by the mandated reporter, the person taking the telephoned report.

IV. INSTRUCTIONS (continued)
SECTION B – REPORT NOTIFICATION: Complete the name and address of the designated agency notified, the date/time of the phone call, and the name, title, and telephone number of the official contacted.

SECTION C – VICTIM (One Report per Victim): Enter the victim's name, birthdate or approximate age, sex, ethnicity, address, telephone number, present location, and, where applicable, enter the school, class (indicate the teacher's name or room number), and grade. List the primary language spoken in the victim's home. Check the appropriate yes/no box to indicate whether the victim may have a developmental disability or physical disability and specify any other apparent disability. Check the appropriate yes/no box to indicate whether the victim is in foster care, and check the appropriate box to indicate the type of care if the victim was in out-of-home care. Check the appropriate box to indicate the type of abuse. List the victim's relationship to the suspect. Check the appropriate yes/no box to indicate whether photos of the injuries were taken. Check the appropriate box to indicate whether the incident resulted in the victim's death.

SECTION D – INVOLVED PARTIES: Enter the requested information for Victim's Siblings, Victim's Parents/Guardians, and Suspect. Attach extra sheet(s) if needed (provide the requested information for each individual on the attached sheet(s)).

SECTION E – INCIDENT INFORMATION: If multiple victims, indicate the number and submit a form for each victim. Enter date/time and place of the incident. Provide a narrative of the incident. Attach extra sheet(s) if needed.

V. DISTRIBUTION
Reporting Party: After completing form BCIA 8572, retain a copy for your records and submit copies to the designated agency.

Designated Agency: Within 36 hours of receipt of form BCIA 8572, the initial designated agency will send a copy of the completed form to the district attorney and any additional designated agencies in compliance with PC sections 11166(j) and 11166(k).

ETHNICITY CODES

1 Alaskan Native
2 American Indian
3 Asian Indian
4 Black
5 Cambodian
6 Caribbean
7 Central American
8 Chinese
9 Ethiopian
10 Filipino
11 Guamanian
12 Hawaiian
13 Hispanic
14 Hmong
15 Japanese
16 Korean
17 Laotian
18 Mexican
19 Other Asian
21 Other Pacific Islander
22 Polynesian
23 Samoan
24 South American
25 Vietnamese
26 White
27 White-Armenian
28 White-Central American
29 White-European
30 White-Middle Eastern
31 White-Romanian