Child and Adolescent Health Service | CAHS - Consumer Reporting Form: Ombudsman Reportable Conduct Scheme

I make the following report to the Chief Executive of the Child and Adolescent Health Service, in accordance with section 19T of the Parliamentary Commissioner Amendment (Reportable Conduct) Act 2022.

I make the following report to the Chief Executive of the Child and Adolescent Health Service, in accordance with section 19T of the Parliamentary Commissioner Amendment (Reportable Conduct) Act 2022.

1. My details

Full name Contact number Email Address

I have formed a belief on reasonable grounds* that a CAHS employee has engaged in reportable conduct.

Under the Reportable Conduct Scheme, an ‘employee’ is defined to include many different types of workers and volunteers. This includes the following persons over 18 years of age:

an officer or employee of CAHS (whether or not they provide services to children).
volunteers and contractors for CAHS (only if they provide services to children).
a person engaged by CAHS as a carer of a child under a placement arrangement under the Children and Community Services Act 2004.
a family day care educator or family day care educator assistant engaged by or registered with the organisation

* The existence of some uncertainty or doubt about whether an employee engaged in reportable conduct or conduct that may involve reportable conduct does not prevent the reporting person from forming a belief on ‘reasonable grounds’ that the reportable allegation occurred.

A reporting person is not required to prove that a reportable allegation occurred.

A person is likely to form the belief on reasonable grounds if they:

observed the child’s behaviour;
observed the conduct themselves;
heard directly from a child that the conduct occurred; or
received information from another credible source (including another witness).

2. Details of the staff member who is the subject of the reportable allegation or conviction

Full name of employee (if known) HE number (staff ID number) (if known) Work location of employee (if known) Any former name or alias of the employee (if known) Physical description of employee (if known)

3. Details of the child / alleged victim(s) (if known)

Full name of child (if known) Your relationship to the child Date of birth of the child (if known) Child's UMRN (if known) Child's gender Does the child have a disability? Is the child culturally and linguistically diverse? Does the child identify as Aboriginal or Torres Strait Islander?

4. Details of the reportable allegation or reportable conviction

Please select which you are reporting

A reportable allegation is any information that leads a person to form the belief that a staff member of an organisation has engaged in reportable conduct, whether or not the conduct is alleged to have occurred in the course of the employee’s employment.

A reportable conviction is, in summary, a conviction for an offence of a sexual nature committed against, with, or in the presence of a child.

If a reportable allegation, please select the type(s) of reportable conduct that are applicable Sexual offence (against, with or in the presence of, a child) Sexual misconduct (against, with or in the presence of, a child) Physical assault (against, with or in the presence of, a child) Significant neglect of a child Any behaviour that causes significant emotional or psychological harm to a child Date(s) of the alleged conduct or conviction (if known). Include start and end date(s) Details of the reportable allegation or reportable conviction

Last Updated: 06/11/2025

Consumer reporting form: Ombudsman Reportable Conduct Scheme

1. My details

2. Details of the staff member who is the subject of the reportable allegation or conviction

3. Details of the child / alleged victim(s) (if known)

4. Details of the reportable allegation or reportable conviction

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