Case ActivityForm – Child Protection cases

to be completed for cases reported to or received from Statutory Authorities

(This form is designed to capture the progress of each individual case thereby providing you with a ‘snapshot’ of the status of a case at any point in time. This form will also assist with the completion of the Annual Report return.)

Definition of a case is: an individual alleged abuser who may have one or more alleged respective victims

Diocese / Religious Congregation:Your Case Identifying Ref:

Date Allegation Made:Date Case closed:

Date Allegation reported to or received from Statutory Authorities:

1. Source of first contact with Safeguarding Office for this case
Source / Tick as appropriate
Alleged victim
Third party
Statutory Agency
Local Rep
Parish priest
2 i. Has the alleged abuser been the subject of allegations in other Dioceses / Religious Congregations?
Yes / No (delete as appropriate) / 2 ii. If yes, please state who is taking lead responsibility?
3. Role of the Alleged Abuser in this case
Clergy / Please Tick as appropriate / Religious / Please Tick as appropriate / Other / Please Tick as appropriate
Secular/Diocesan Priest / Male Religious (exc Priests) / Volunteer
Religious Priest / Female Religious / Employee
Transitional or Permanent Deacon / Religious in Formation
(male & female) / Parishioner
Secular/Diocesan and Religious Clerical Students
4. Date First Alleged Abuse Occurred (Main Type of Abuse per Each Victim) in this case
Year in which Alleged Abuse first occurred (per victim / Sexual abuse / Physical abuse / Emotional abuse / Neglect / Child Abusive Images / Total
YEARS 2012-2000
01.01 – 31.12.12
01.01 – 31.12.11
01.01 – 31.12.10
01.01 – 31.12.09
01.01 – 31.12.08
01.01 – 31.12.07
01.01 – 31.12.06
01.01 – 31.12.05
01.01–31.12.04
01.01–31.12.03
01.01 –31.12.02
01.01–31.12.01
01.01–31.12.00
DECADES 30s – 90s
01.01.90 – 31.12.99
01.01.80 – 31.12.89
01.01.70 – 31.12.79
01.01.60 – 31.12.69
01.01.50 – 31.12.59
01.01.40 – 31.12.49
01.01.30 – 31.12.39
PRE 1930
TOTALnumber of alleged victims per type of abuse
5. What actions have been taken within the Church?
Action / Date Implemented / Effective / Date Action Ceased / Tick to identify conclusion of case
Processes
Awaiting Outcome of Statutory Investigation / Not applicable
Administrative leave, suspension or equivalent, pending investigations / Not applicable
Organisation disciplinary procedures in progress (in Canon Law or Employment Procedures) / Not applicable
Restricted, pending investigation / Not applicable
Risk Assessment / Not applicable
Decisions
Reinstatement/No Further Action
Warning/Training
Restricted ministry/work under supervision
Dismissal/Removal from office/Order/employment/role/active ministry
Laicisation
Resigned
Risk Management Plan in place
Reported to ISA by Safeguarding persons
6. What Action has been taken by Statutory Authorities?
Date Action Occurred / Tick to identify case closure
Investigation initiated and in progress
Statutory Authorities – No Further Action
Police caution
Court hearing
Conviction
Sentence
Report to ISA