WEBFORM - for external use

Child Safe Organisations Act 2024 (Qld)

REPORTABLE CONDUCT FORM

The Queensland Family and Child Commission ("QFCC") oversees the Reportable Conduct Scheme, which promotes child-safe organisations and helps ensure concerns regarding the conduct of workers towards children are appropriately reported, investigated and managed.

The Diocese of Cairns ("Diocese") enourages anyone to complete this form to report their concerns of a workers conduct towards a child. Upon receipt of the form, the Diocese will assess the information provided and determine the appropriate response in accordance with the Child Safe Organisations Act 2024 (Qld), the requirements of the Reportable Conduct Scheme and all relevant legislation, policies and procedures.

Please note:

If a child is in immediate danger, call Queensland Police on 000.
Completing this form does not prevent you from reporting your concern directly to the Police or another relevant authority.
The Bishop of Cairns, as the Head of the Entity for the Diocese has authorised the Professional Standards and Safeguarding Office to notify QFCC of reportable conduct matters, where required by law.
Any person may submit reportable conduct concerns directly to the QFCC.
Where a concern is reported directly to the QFCC, the matter may be referred to the Diocese Professional Standards and Safeguarding Office for assessment and investigation.

If you are unsure whether your concern constitutes reportable conduct, we encourage you to submit the notification or contact the Professional Standards and Safeguarding Office for advice.

Part 1 - Privacy

The Diocese of Cairns is committed to protecting the privacy and confidentiality of reportable conduct matters in accordance with applicable laws, QFCC requirements and the Child Safe Organisations Act 2024 (Qld). Information will only be shared with Police or other relevant authorities where required or authorised by law.

Providing your contact details assists the Diocese to assess, verify and respond appropriately to reportable conduct concerns.
If you prefer to remain anonymous, this may limit the action the Diocese or the Commission (QFCC) can take to investigate reportable conduct.

Can the Diocese of Cairns contact you regarding your concern/s? *

YesNo

As you complete the form, if you do not have all the details, please provide as much information as you can.

Part 2 - Your Details

First Name

Last Name

Phone

Your Address

Street Address

City

State

Postcode

Are you a volunteer, contractor, consultant or sole trader with the Diocese of Cairns?

YesNo

Part 3 - Details of the Reportable Conduct

3.1 The Parish/Ministry/Diocesan service where the conduct occurred

Select the Parish, Ministry or Diocesan serviceClick on the arrow for the dropdown menu. Select 'other' if the site/location is not listed.

3.2 Provide details of the worker or volunteer this report is about

First Name

Last Name

Gender

MaleFemaleNon BinaryOther

What is their role?

Are you aware if the worker or volunteer is employed by any other organisation/s?

YesNoUnknown

3.3 Details of the reportable conduct

What date did the reportable conduct occur?

Primary allegation type

Secondary allegation typeOnly complete if you are reporting more than one conduct type

When did the reportable conduct occur?

During their hours of work or volunteering with the DioceseIn their private time (outside of work hours)

Is the worker or volunteer aware of the allegation?

YesNoUnknown

Details of the allegation or conviction

What date did you become aware of the reportable conduct?

How did you become aware of the reportable conduct?

Victim disclosureThird party disclosure (another person told you)You witnessed the incidentOther notification

Have you told any other member of the Diocese of your concerns?

YesNo

Part 4 - Details of the Victim

First Name

Last Name

Date of Birth

Age when the reportable conduct occurred

Gender

MaleFemaleNon BinaryOther

Is the victim a person with disability?

Is the victim from a culturally and linguistically diverse community?

Does the victim identify as an Aboriginal person or a Torres Strait Islander person?

Are you aware if the victim's parent/guardian/carer has been notified of these concerns?

YesNoUnknown

Is there more than one victim?

YesNo

First Name

Last Name

Date of Birth

Age when the reportable conduct occurred

Gender

MaleFemaleNon BinaryOther

Is the victim a person with disability?

Is the victim from a culturally and linguistically diverse community?

Does the victim identify as an Aboriginal person or a Torres Strait Islander person?

Are you aware if the victim's parent/guardian/carer has been notified of these concerns?

YesNoUnknown

Are there more than two victims?

YesNo

First Name

Last Name

Date of Birth

Age when the reportable conduct occurred

Gender

MaleFemaleNon BinaryOther

Is the victim a person with disability?

Is the victim from a culturally and linguistically diverse community?

Does the victim identify as an Aboriginal person or a Torres Strait Islander person?

Are you aware if the victim's parent/guardian/carer has been notified of these concerns?

YesNoUnknown

Are there more victims?

YesNo

Part 5 - Other Agencies

Have you reported the concerns to another agency or regulator?

YesNo

Which agency has the concern been referred to?

Reported to Police

Reported to Child Safety

Blue Card Services

Other:

Part 6 - Additional Information

Is there any additional information you would like to provide?

YesNo

Part 7 - Attachments

To assist in a timely assessment of your notification, please provide copies of all relevant records on hand, including any initial statements, incident reports, CCTV footage or other evidence.

Maximum individual file size is 5MB. Maximum total file size is 25MB.

If you cannot attach your documents, please email them to professionalstandards@cns.catholic.edu.au

Upload your information

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Part 8 - Your Declaration

By submitting this form, you affirm that, to the best of your knowledge, the information provided in this form is accurate and truthful. *