Child Abuse Reporting

Report Child Abuse

Minnesota Statutes Section 260E : Any professional who knows or has reason to believe a child is being neglected or physically or sexually abused, or has been neglected or physically or sexually abused within the preceding three years, shall immediately report the information to the local welfare agency, agency responsible for assessing or investigating the report, police department, or the county sheriff. An oral report shall be made immediately by telephone or otherwise. Report shall be followed within 72 hours, exclusive of weekends and holidays, by a report in writing.

ST.LOUIS COUNTY CHILD MALTREATMENT REPORT

ORAL REPORT INFORMATION

Did you call this report in?

Yes

Date of Oral Report

Name of Person you spoke with?

Location of Report

Duluth - (218) 726-2012

Virginia - (218) 471-7128

Does this report involve a foster home or childcare provider?

Yes

MANDATED REPORTER INFORMATION

Reporter Name
Agency
Phone
Email
Relationship to Victim

Mandated Reporter Agency Mailing Address

Street Address

City

State

Postal Code

Send final screening decision to reporter?

IDENTIFYING INFORMATION OF ALLEGED VICTIM(S)

Child Name
Age or Date of Birth
Additional Children - please list name and age

Do you know or have reason to believe any of these children have American Indian/tribal heritage?

Yes

Unknown

Tribal affiliation, if known

Language/Cultural considerations
Name of School and/or Daycare

PARENT/GUARDIANS OF ALLEGED VICTIM

Parent/Guardian #1
Address #1
Phone #1
Parent/Guardian #2
Address #2
Phone #2
Family strengths/family support people
Child vulnerability and/or current family stressors (behavior concerns, medical diagnose, mental health concerns, poverty, etc.)

PERSON BELIEVED TO BE RESPONSIBLE FOR THE ABUSE OR NEGLECT

Name
Address
Phone
Age

INCIDENT REPORT

Type of alleged abuse

physical

sexual

neglect

Does the person believed to be responsible for the abuse or neglect have access to the child(ren)?

Yes

Unknown

Please give all the information and details that you know including dates, harm/injury to child, etc

Files types accepted: images, pdf, video