VULNERABLE PERSON ABUSE REPORTING FORM

Your Information

• Name:
• Email:
• Title/Role:
• Address:
• Phone Number:
• Would you like to be contacted by a Victim Advocate?:

  Yes
  No
  

Vulnerable Person Information

• Name:
• DOB/Age:
• Address and Contact Information:
• Guardian:
• Relevant Information:

Incident Information

• Personnel Involved:

  ==Please select==Church EmployeeClergyVolunteer
• Incident Type:

  ==Please select==FinancialPhysical Abuse/NeglectSexual MisconductOther
• Date of Incident:
• Time of Incident:
• Location of Incident/Address:
• Specific Area at Location (ex. hallway, classroom, playground, etc.):
• Detailed Incident Description:
• Witnesses (if known, include names, addresses, phone numbers, etc.):

Offender/Suspected Offender Information

• Name:
• Title/Role/Relationship:
• Contact Information (Address, Phone Number, etc.):

Reporting Information

• Notifications made to (check that all apply):

  Caregiver
  Human/Social Services
  Ministry Leader
  Parents/Guardian
  Parish Safe Environment Coordinator
  Pastor/Principal
  Police
  
• Notification Related Information (ex. police case report number, officer name, etc.):
• Parish Name:
• reCAPTCHA:

DEPARTMENTS OF HUMAN SERVICES

• Chaffee County Adult Protection - DHS
• Cheyenne County Department of Human Services
• Colorado State Department of Human Services
• Douglas County Health and Human Services
• Elbert County Health and Human Services
• El Paso County Adult Protective Services
• Kit Carson Human Services
• Lake County Adult Protective Services
• Lincoln County Department of Human Services
• Park County Adult Protective Services
• Teller County Department of Human Services

OPTIONS FOR REPORTING ABUSE

• Report Child Abuse
• Report Fraud and Theft
• Report Sexual Misconduct by a Bishop
• Report Vulnerable Persons Abuse
• Reportando un Abuso

RELATED DOCUMENTS

• Guidelines for Working with Children and Youth
• Interactions and Behaviors Summary
• Sexual Misconduct Policy
• Sexual Misconduct Policy (Spanish)
• Special Master's Report (October 2019) - Roman Catholic Clergy Sexual Abuse of Children in Colorado from 1950 to 2019

OTHER RESOURCES

• Safe Environment Training
• USCCB - Complete Charter Information
• VIRTUS
• What is the Process for when a Report of Abuse is Made?