Reporting Cases of Violence Against Children

Child Violence Case Reporting Form

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a) Name/Initials

No need to complete if you want to report anonymously

b) Position & Organization *

Complete if you are reporting in a professional capacity regarding the violence that occurred

c) Contact *

Email/phone/address

d) Relationship with the child (victim) *

A child is someone who is not yet 18 years old, including children who are still in the womb (Law 35 of 2014 concerning amendments to Law No. 23 of 2002)

e) Violence that occurs *

• Physique
• Sexual
• Exploitation
• Emotional
• Neglect

Can report more than one.

f) Description of the incident *

Time, place, sequence of events, indications of violence and other important notes related to the observation

Description Contact information

g) Supporting information *

Photos, police/hospital examination results, witness information, if available and appropriate to provide

h) Matters that require immediate attention *

The victim’s medical condition, other children who are at risk, whether the child is in danger

i) Basic information about the victim *

Name: Age: Gender: Address (child’s current location):

III) INFORMATION REGARDING THE PARTY ALLEGED TO BE THE PERPETRATOR *

Name: Relationship to child (victim): Contact address & location (if known):

Has the person concerned previously been linked to any cases of violence?

• Yes
• No

If Yes, please explain what you know:

Submit

SUBMISSION

Thank you for reporting a suspected case of child abuse to INOVASI. The identity of the reporter will be kept confidential. Every report will be taken seriously and followed up in accordance with INOVASI’s child protection policy.
Together, we can create a safe and violence-free environment for all children.
For more information, please contact:

📞 0811-9005-6823
📧  inovasi.perlindungananak@thepalladiumgroup.com