Mandatory Reporter Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Reporter (Florida Public School Personnel) *FirstLastEmailPhone * / Signature / School / District *Consent / AcknowledgmentI acknowledge that any person who knows, or has reasonable cause to suspect that a child is abused, abandoned, or neglected must report such knowledge or suspicion to the Florida Abuse Hotline (Section 39.201(1)(a), Florida Statutes).I understand that school teacher or other school official or personnel are required to provide their names to child abuse hotline staff (Section 39.201(1)(b), Florida Statutes) and that names of reporters are held confidential.I understand the Florida Abuse Hotline reporting options: Telephone 1-800-96-ABUSE (1-800-962-2873); TDD 1-800-453-5145; Fax 1-800-914-0004; Internet http://www.dcf.state.fl.us/abuse/report.I understand that if the report is of known or suspected child abuse by someone other than a parent, legal custodian, caregiver, or other person responsible for the child’s welfare, the call shall be immediately electronically transferred to the appropriate county sheriff’s office by the Abuse Hotline (Section 39.201(2)(b), Florida Statutes).I acknowledge the ethical obligation under Rule 6B-1.006, Florida Administrative Code to promote the well-being of all students and make reasonable efforts to protect the student from conditions harmful to learning and/or to the student’s mental and/or physical health and/or safety.Date / Time of ConsentDateTimeSignature Clear Signature Submit
