Child Abuse Risk Assessment Report

General Information

Child's Name Date of Birth Date of Assessment Assessor Name Case/Reference Number

Identified Risk Factors

Type(s) of Suspected Abuse Physical Emotional Sexual Neglect Other Details/Indicators Noted Relationship to Alleged Abuser(s)

Assessment Findings

Summary of Observations Child's Statements / Disclosures Statements by Others (e.g., caregivers, witnesses)

Protective Factors

Protective Relationships & Supports Child's Resilience / Coping

Risk Evaluation

Current Level of Risk Low Medium High Critical Rationale for Risk Level

Recommendations / Actions

Immediate Actions Taken Recommended Follow-up / Support Referral to Other Agencies

Assessor Signature Date