Certificate III in Early Childhood Education and Care - Project Assessment

Assessment instructions and details for a project-based assessment for the CHCPRT001 – Identify and respond to children and young people at risk unit under CHC30121 | Certificate III in Early Childhood Education and Care, CHC30221 | Certificate III in School Based Education Support, CHC40221 | Certificate IV in School Based Education Support, CHC50221 | Diploma of School Age Education and Care. The assessment consists of scenarios, Risk of Significant Harm (RoSH) Report, and short answer questions.

1. Project assessment
Criteria
Unit code and name
CHCPRT001 – Identify and respond to children and young people at risk
Qualification/Course code and name
CHC30121 | Certificate III in Early Childhood Education and Care
CHC30221 | Certificate III in School Based Education Support
CHC40221 | Certificate IV in School Based Education Support
CHC50221 | Diploma of School Age Education and Care
Student details
Student number
Student name
Assessment declaration
Note: If you are an online student, you will be required to complete this declaration on the
TAFE NSW online learning platform when you upload your assessment.
This assessment is my original work and has not been:
 plagiarised or copied from any source without providing due acknowledgement.
 written for me by any other person except where such collaboration has been
authorised by the Teacher/Assessor concerned.
Student signature and date

Version: 20220224
Date created: 22:57
Date modified: 29/08/24
For queries, please contact:
Health, Wellbeing and Community Services SkillsPoint
Queanbeyan
© 2022 TAFE NSW
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This assessment can be found in the: Learning Bank
TAFE NSW has reproduced and contextualized parts of this work, as per the terms and conditions of the
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please contact the Health, Wellbeing and Community Services SkillsPoint, Queanbeyan.
The contents in this document is copyright © TAFE NSW 2022 and should not be reproduced without the
permission of TAFE NSW. Information contained in this document is correct at the time of printing: 23 February
2022. For current information please refer to our website or your Teacher/Assessor as appropriate.

Assessment instructions
Table 1 Assessment instructions
Assessment details Instructions
Assessment
overview
The objective of this assessment is to assess your skills and
knowledge required to support and protect children and young
people who are at risk of harm. This work occurs within legislative
and policy frameworks and carries a duty of care responsibility.
Assessment event
number
2 of 3
Instructions for
this assessment
This is a project-based assessment that assesses your
knowledge and performance of the unit.
This assessment is in two parts:
 Part 1: Scenarios
 Part 2: Risk of Significant Harm (RoSH) Report
 Part 3: Short answer questions
And is supported by:
 Part 4: Assessment checklist
 Assessment feedback
 Appendix 1 - Risk of Significant Harm (RoSH) Report
Note: This assessment may contain links to external
resources. If a link does not work, copy and paste the URL
directly into your browser.
Submission
instructions
On completion of this assessment, you are required to
submit it to your Teacher/Assessor for marking. Where
possible, submission and upload of all required assessment
files should be via the TAFE NSW online learning platform.
It is important that you keep a copy of all electronic and
hardcopy assessments submitted to TAFE and complete the
assessment declaration when submitting the assessment.
What do I need to
do to achieve a
satisfactory
result?
To achieve a satisfactory result for this assessment, you
must answer all the questions correctly.
If a resit is required to achieve a satisfactory result, it will be
conducted at an agreed time after a suitable revision period.
What do I need to
provide?
• TAFE NSW student account username and
password. If you do not know your username and
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Assessment details Instructions
password, contact your campus or service centre on
131601.
• Computer or other device with word processing
software and internet access
• Writing materials, if required
What the
Teacher/Assessor
will provide
Access to this assessment and learning resources, including
the student workbook and any supporting documents or
links.
Due date
Time allowed
Location
Refer to training plan
6.5 hours (indicative only)
Assessment is to be completed out of class.
Assessment
feedback, review
or appeals
In accordance with the TAFE NSW policy Manage
Assessment Appeals, all students have the right to appeal
an assessment decision in relation to how the assessment
was conducted and the outcome of the assessment.
Appeals must be lodged within 14 working days of the
formal notification of the result of the assessment.
If you would like to request a review of your results or if you
have any concerns about your results, contact your
Teacher/Assessor or Head Teacher. If they are unavailable,
contact the Student Administration Officer.
Contact your Head Teacher/Assessor for the assessment
appeals procedures at your college/campus.
Specific task instructions
The instructions and the criteria in the tasks and activities will be used by your
Teacher/Assessor to determine if you have satisfactorily completed this assessment
event. You should refer to the list of criteria in the Assessment Checklist to
understand what you need to demonstrate in this section of the assessment.
Important Self-awareness warning
Please note there is specific content in this resource that relate to different aspects of
diversity and identity. If you find any of the content upsetting or distressing, please
talk to your teacher or contact the relevant support service:
Aboriginal Student Support Services (Email -
[e-mail])
Accessibility and disability services (Long URL - https://www.tafensw.edu.au/student-
services/disability-services)

Personal counselling (Long URL - https://www.tafensw.edu.au/counselling-career-
development-services/personal-counselling-wellbeing)
International students (Long URL - https://www.tafensw.edu.au/counselling-career-
development-services/personal-counselling-wellbeing)
Multicultural support (Long URL -
https://www.tafensw.edu.au/student-services/multicultural-student-support).
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Part 1: Scenarios
To complete this part of the assessment, you must read two scenarios and complete
questions in the spaces provided. You will need to ensure that you take note of the
volume of response requirement where indicated.
Your responses must demonstrate your ability to:
 recognise indicators for potential ethical concerns when working with children
and young people
Question 1
Choose and respond to one scenario only. Read the scenario and answer the
question below.
Table 2 Scenario 1: Early childhood (0-6 years)
Scenario 1: Early childhood (0-6 years)
It is the start of lunch in the toddler room and there are ten 2-3-year olds with two
educators. Everyone has just started to eat their spaghetti bolognaise. Mark has
been toilet training in the last few weeks and suddenly begins to cry. Safa, one of
the educator's notices that Mark has had a toileting accident and a puddle is
starting to form under his chair. Safa announces to the other educator, “Mark has
wet their pants, again, what a cry baby, maybe Mark needs to go back in nappies
like the babies”. The other educator Wendy says, “Well Mark can just sit in it and
think about what they have done as I am enjoying my lunch”.
Mark continues to cry throughout lunch and doesn’t eat any of his spaghetti as
lunch continues for the educator and the other children. At the end of lunch, Mark is
extremely upset and Safa says, “I suppose I better clean this baby up”. Safa stands
Mark in the middle of the room and removes all the wet clothing. She uses wipes to
wipe Mark down and redresses Mark in front of everyone. Sally then directs Mark
to lay on his bed. In the afternoon Wendy posts on the services app for all parents
to read. “The children enjoyed their spaghetti today for lunch except, for Mark who
wet their pants”. Mark’s Mum calls the centre in the afternoon disgusted by the
comment and makes an official complaint.
Table 3 Scenario 2: School based (5-12 years)
Scenario 2: School based (5-12 years)
It is the start of term 1 and the kindergarten class is eating their lunch indoors.
Everyone has just started to eat. Mark suddenly begins to cry. Safa, another
School Learning and Support Officer notices that Mark has had a toileting accident
and a puddle is starting to form under his chair. She announces to the teacher,
“Mark has wet their pants, again, what a cry baby, maybe Mark needs to go back to
preschool”. The class teacher says, “Well he can just sit in it and think about what
he has done as I am enjoying my lunch”.
Mark continues to cry throughout lunch and doesn’t eat any of his lunch. At the end
of lunch Mark is extremely upset and Safa says, “I suppose I better clean this baby

up”. Safa directs Mark to the bathroom with a change of clothes. Mark’s Mum calls
the school in the afternoon disgusted by the comment and makes an official
complaint.
1. Identify one (1) ethical concern from the scenario. Provide a short explanation
as to why you have selected this. (20-40 words)
Scenario 1: Ethical concern is that the educator Safa does not took Mark's concern
before changing his pants and that too in front of everyone present there in the
room. I have selected the scenario to explain the ethical principle of taking concern.
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Question 2
Choose and respond to one scenario only. Read the scenario and answer the
question below.
Table 4 Scenario 1: Early childhood (0-6 years)
Scenario 1: Early childhood (0-6 years)
Blake is an educator in the Preschool Room. Blake’s friend George has a child that
attends the centre. George drops off their daughter Yasmeen in a rush. During
lunch break Blake receives a text from George. George informs Blake that there
are antibiotics in Yasmeen's bag. George asks Blake to give Yasmeen 5mls at
lunch time. Blake texts back and says, “I can’t give Yasmeen the medication
without a completed medication form.” George replies “just this once and I will fill
the form out this afternoon”. Blake returns from the lunch break and calls Yasmeen
over to where their backpack is kept. Blake takes the medication out and gives her
5mls and then puts the medication back in Yasmeen’s bag. When George arrives
in the afternoon, Blake tells George I gave it to Yasmeen but just keep this
between you and me.
Table 5 Scenario 2: School based (5-12 years)
Scenario 2: School based (5-12 years)
Mr. J is a very popular SLSO with the students. Mr. J often converses and jokes
with the students during and between classes. It is common for Mr J. to greet
female students and staff with a hug and male students and staff with a pat on the
back. One student has complained to the administration that Mr. J’s hugs or
physical contact makes them uncomfortable. Mr. J has been advised by the
principal to stop all physical contact with students and staff. He agrees to try, but
he can’t promise anything because that is the way Mr J. is and it isn’t doing
anything wrong. You see Mr J. hugging the student who has complained.

2. Identify one (1) ethical concern from the scenario. Provide a short explanation
as to why you have selected this. (20-40 words)
Scenario 1: Ethical issue is that George requested Blake to give antibiotics to
Yasmeen and Blake convinced and did that even without referring medication form.
It is an ethical issue to give medication to such a small child without seeing
prescription.
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Part 2: Risk of Significant Harm (RoSH) Report
To complete this part of the assessment, you must choose either the early childhood
or school based scenarios and complete two Risk of Significant Harm (ROSH)
reports (appendix 1).
Choose either the early childhood or school based scenarios and complete a
Risk of Significant Harm (RoSH) Report for each scenario (refer to instructions
below):
 Early childhood scenarios (0 - 6 years) OR
 School based scenarios (5 – 12 years)
Your responses must demonstrate your ability to:
 identify children and young people at risk of abuse or neglect by observing
signs and symptoms
 be aware of protective issues
 use child protection procedures where appropriate
 respond to disclosure, information or signs and symptoms
 comply with regulations, legislations and duty of care responsibilities and the
service policies and procedures
 ensure decisions and actions taken are within own level of responsibility, work
role, state legislation and service policies and procedures
 accurately record relevant specific and general circumstances surrounding risk
of harm in accordance with state legislation, service policies and procedures
and ethics
 promptly record and report risk-of-harm indicators, including the circumstances
surrounding the risk of harm according to service policies and procedures
 ensure writing in reports is non-judgemental
 act to protect the rights of children and young people in the provision of
services
 read and understand forms and to make accurate reports
 write to record details of children and young people at risk and to make reports
using handwritten skills

Risk of Significant Harm (RoSH) report instructions:
 print, complete and submit a handwritten Risk of Significant Harm (ROSH)
report 1 and 2, located in Appendix 1. Ensure the details in these reports are
objective and non-judgemental.
 access the online Mandatory Reporter Guide (MRG) (Long URL:
https://reporter.childstory.nsw.gov.au/s/mrg) at ChildStory Reporter and
complete the relevant decision tree for the chosen scenario. Print and attach a
copy of the final decision report.
How you will be assessed: You should refer to the list of criteria in the Assessment
Checklist (Part 4) to understand what you need to demonstrate in this section of the
assessment.
Table 6 Early childhood scenarios (0-6 years)
Early childhood child scenarios (0 – 6 years)
For the purposes of these child protection scenarios, you are employed by the
simulated organisation Little.ly (long URL: www.littlely.eduworks.com.au).
Scenario 1: Early Childhood (0 – 6 years)
Mack (3 years) attends childcare five days per week. Mack has a 2-year-old
brother, Adrian. Mack has no contact with their father however, Adrian, sees their
father intermittently. Mack’s mother, Alice, lives with Alice’s current partner, Jian.
The family are also known to a number of community support agencies who
regularly assist with food and clothing for the children.
Mack tends to assume a protective role with Adrian. Mack is very self-sufficient and
often takes whatever food Mack can find in the house for them both. At childcare,
Mack tends to be a loner. Mack finds it difficult to share and likes to spend time
doing puzzles, drawing, playing with construction sets, and looking at books.
Adrian also attends the centre and Mack insists on checking on Adrian several
times a day.
It is 9:45 am and Mack and Adrian arrive at the centre with Jian. The children are
wearing the same clothes they have worn for the previous two days. Adrian’s
nappy is soaking, and his pants are wet. Adrian is bathed and changed and Kim
(Adrian’s Educator) notes that he has quite severe nappy rash. It is a warm day
and Mack is wearing a long-sleeved top and jeans. Mack is persuaded to remove
their top and put on a T-shirt. Kim notices that Mack has bruises of different colours
on both of his upper arms. He also has a purple-reddish bruise on his forehead.
Several of the staff later comment to the Director that the children ‘would be better
off without Alice and Jian’. The Director acknowledges that the situation is very
stressful and reminds the team that they must act in an ethical manner. It is not up
to the team to judge the family, but only to advocate for the best interests of the
children. The Director reminds staff not to discuss the incident with other parents.
Staff follow the Director's instruction but continue to discuss the incident amongst
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themselves without regard for their whereabouts or who is around when holding
these discussions. One staff member continues to remark “it would be so much
easier if we only had to work with the children and didn’t have to think about the
parents.” Many of the remaining staff laugh at this and agree.
Scenario 2: Early Childhood (0 – 6 years)
Alinta (4 years) has been in your childcare centre for the past 18 months and
attends childcare five days a week. Over this time, you have noticed that the
approaches to Alinta by Alinta’s Mother and Father are very different. Alinta’s
Mother, Mayleen, is very calm and encouraging towards Alinta whilst the Father,
Maliyan, is very stern and abrupt.
Maliyan’s expectations of what Alinta should be doing is well above Alinta’s age
and developmental stages. Alinta is meeting the expected developmental
milestones. Alinta actively engages in learning through play, however, Maliyan
questions the type of activities Alinta engages in and tells Alinta to only undertake
structured learning activities and demands staff provide these. Staff have tried to
explain the value of the unstructured play experiences provided in the environment,
but Alinta’s Father appears unsatisfied and continues to direct Alinta to certain
experiences only.
When you have attempted to raise your concerns with Mayleen, who you find more
approachable, Mayleen discloses that they lost a son, Shing, three years before
Alinta was born. Shing was tragically killed walking home from school when a
drunk driver whose car mounted the curb. Shing was at primary school and was
deemed to be ‘gifted and talented’ and in Mayleen’s view, Maliyan is wanting Alinta
to be as ‘academically able as Shing’. Mayleen confides that she is concerned that
Maliyan places too much pressure on Alinta because Maliyan is seeking to make
Alinta into a surrogate for Shing.
You have noticed a change in Alinta when their father collects them. Alinta
becomes more withdrawn and subdued. In observing Maliyan one day you are
uncomfortable with Maliyan strapping Alinta into the car. In your view, Maliyan was
overly disciplining Alinta for not completing their letter formation. Maliyan is yelling
so loudly at Alinta that the other children in the centre are becoming visibly upset
and are cowering behind the other educators. You now regret telling Maliyan in
your feedback that Alinta found it very difficult to focus during today’s learning
activities and was easily distracted and playing around with a couple of the other
girls.
The following day, Maliyan arrives to drop off Alinta. Maliyan seems very quiet and
quickly clings to the main educators' leg. Maliyan leaves and the educator attempts
to engage Alinta in one of their favourite activities. Alinta sits at the table but does
not engage. Alinta continues to be withdrawn throughout the morning.
Table 7 School based scenarios (5-12 years)
School based scenarios (5 – 12 years)
For the purposes of these child protection scenarios, you are employed by the
simulated organisation Wetlands Central School (WCS) (Long URL:
https://share.tafensw.edu.au/share/file/92d77258-406f-4e95-946c-459fd493fd7c/

1/Wetlands.zip/Wetlands/index.html).
Scenario 1: School based (5-12 years)
Marlee is the mother of Lowanna, a 6 year old girl who attends your school. Marlee
arrives to drop Lowanna off very distressed. Marlee says their partner Aalam has
been very depressed and won’t seek help. Aalam has been explosive and
unpredictable lately often getting annoyed with Lowanna. Aalam became agitated
when Marlee and Lowanna were getting in the car, accusing Marlee of wanting to
leave Aalam. Aalam pushed Marlee to the ground and kicked Marlee several times.
Finally, Marlee was able to get away and drove straight to the school. Marlee says
they hopes Lowanna couldn’t see from the car. As you talk to Marlee, you notice
that Lowanna is clinging to their mother. Lowanna is crying quietly.
Scenario 2: School based (5-12 years)
Lenne is a 5 year old boy who attends the school you are employed at. Lenne has
a good relationship with both the staff and their peers. Lenne is usually well
behaved in class and likes to participate in most activities. After the last school
holidays, Lenne has starting picking fights with their peers. Lenne has become
aggressive towards a male staff member and fathers bringing their children to the
school and has started swearing. Lenne keeps to themself. Lenne has started
wearing jumpers and long pants even on warmer days and shows signs of being
overheated. When encouraged to take of their jumper Lenne says that they were
told they are not allowed to take it off. After further discussion and insistence due
to the fact that Lenne is overheating, Lenne agrees to take it off revealing a mass
of red welts and recent scarring. Lenne says, “Dad told me not to take off my
jumper, will I get into trouble now? I don’t want Dad to hurt me again.”
You overhear a group of staff discussing and talking about Lenne and making
judgemental comments about the family. One of them said that the family are real
low-lives and don’t understand why people bother having children at all. The staff
continued to discuss the incident among themselves with little regard for their
whereabouts and that other children were around.
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Part 3: Short answer questions
To complete this part of the assessment, you must read one scenario and complete
responses to questions in the spaces provided. You will need to ensure you take
note of the volume of response requirement where indicated.
Your responses must demonstrate your ability to:
 ensure decisions and actions taken are within own level of responsibility, work
role, and service policies and procedures
 ask open and non-leading questions
 work collaboratively with relevant agencies to ensure maximum effectiveness
of report
 identify and seek supervision support for issues of ethical concern in practice
with children and young people
Question 1
Reflect on the Part 2 scenarios, the written RoSH reports and the action you took to
ensure the children’s safety.
1. Reflect on the relevant scenario from Part 2. Identify three (3) ways you
adhered to the relevant Child Protection Policy and Procedure.
From scenario 1: (School based) The three ways to protect child are:
 Make Marlee understand about the impact of fights on the mind of a
children and warn parents to not repeat that again in front of Lowanna.
 Written legal complaint can be filed against Lowanna's parents in case of
violating the mental health of a child.
 Written request can be filed by Marlee to remove Aalam from the custody
of Lowanna.
2. Reflect on the relevant scenario from Part 2. Identify one open and non-
leading question you could have asked the child.
Lowanna could have asked about what option she wants to adopt; like if she
wants to live with her mother but separated from father or she did not want to live
with either of them and wants to live in child care centre.

3. Reflect on the relevant scenario from Part 2. Identify how you could work
collaboratively with relevant agencies to ensure maximum effectiveness of
report.
To ensure maximum effectiveness of report, it is important to taker follow- up by
discussing the whole matter with the relevant agencies and request them to take
actions as soon as possible for the sake of the child protection. To work in a
collaborative way, agencies can be provided with required information about the
family and child like address, names, profession of parents, etc.
Following from the scenario from part 2, you will have noticed, a group of staff are
discussing the incident with other parents and making comment about the family.
You have a personal relationship with several of the staff and you do not want to get
them into trouble.
4. Do you think this is appropriate? Why or why not?
This is inappropriate to talk about other's matters to unauthorised ones and make
them comment over other issues. Because it is against the ethics and child may
have to face disgusting nature from their peers when they come to know about
this from their parents. Such activity can disturb the mental health of the child. As
well it may impact the reputation of the school and involving staff members may
also get into trouble.
5. Who should you report your concerns to?
It is better to report the concern to managing directors and request them to take
actions or release strict order regarding the issue of sharing other's family
problems to other parents. Staff members should be ordered to attend the
meeting and discuss the circumstances that a child may have to face due to
unethical practices done by staff members or any other member from
organisation.
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Part 4: Assessment checklist
The following checklist will be used by your TAFE NSW Teacher/Assessor to mark your performance against the assessment
criteria of your assessment tasks. Use this checklist to understand what skills and/or knowledge you need to demonstrate during
this assessment event. All the criteria described in this assessment checklist must be met.
Table 8 Assessment checklist
PART Instructions S U/S Assessor comments
Part
1
Scenarios
1 Selected the correct scenario and identified one ethical concern
from the scenario. Provided a short explanation as to why the
ethical concern was selected.
☐ ☐
2 Selected the correct scenario and identified one ethical concern
from the scenario. Provided a short explanation as to why the
ethical concern was selected.
☐ ☐
Part
2
Risk of Significant Harm (RoSH) Report
1 Submitted two handwritten Risk of Significant Harm (ROSH)
reports on the correct template (appendix 1).
☐ ☐
2 Submitted two copies of the completed final decision report
from the online Mandatory Reporter Guide (MRG).
☐ ☐
3 Completed each report objectively and in a non-judgemental
manner.
☐ ☐

PART Instructions S U/S Assessor comments
4 Identified the risk of abuse or neglect by observing and
documenting signs and symptoms.
☐ ☐
5 Demonstrated compliance with regulations, legislations and
duty of care responsibilities and the service policies and
procedures.
☐ ☐
6 Accurately recorded relevant specific and general
circumstances surrounding risk of harm in accordance with
state legislation, service policies and procedures and ethics.
☐ ☐
7 Demonstrated the ability to read and understand the RoSH form
and make accurate reports.
☐ ☐
Part
3
Short answer questions
1 Identified three ways of adhering to the relevant Child
Protection Policy and Procedure in Part 2.
☐ ☐
2 Identified one open and non-leading question that could have
been asked of the child.
☐ ☐
3 Identified one strategy to work collaboratively with relevant
agencies to ensure maximum effectiveness of report.
☐ ☐
4 Identified the ethical concern and provided a justification of why
the behaviour is appropriate or inappropriate.
☐ ☐
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PART Instructions S U/S Assessor comments
5 Identified the correct line manager to report concerns. ☐ ☐

Assessment feedback
NOTE: This section must have the Teacher/Assessor and student signature to
complete the feedback. If you are submitting through the TAFE NSW online learning
platform, your Teacher/Assessor will give you feedback via the platform.
Assessment outcome
☐ Satisfactory
☐ Unsatisfactory
Assessor feedback
☐ Has the assessment declaration for this assessment event been signed and
dated by the student?
☐ Are you assured that the evidence presented for assessment is the student’s
own work?
☐ Was reasonable adjustment in place for this assessment event?
If yes, ensure it is detailed on the assessment document.
Comments:
Assessor name, signature and date
Student acknowledgement of assessment outcome
Would you like to make any comments about this assessment?
Student name, signature and date

Appendix 1: Risk of Significant Harm (RoSH) Report
Table 9: Experience plan template
Risk of Significant Harm (RoSH) Report
Child and/or Young Persons Details:
Date
Child/young persons name
Date of birth Age
Address
Phone
Gender ☐ Male ☐ Female
Does the child/young person need an Interpreter: ☐ Yes ☐ No ☐ N/A
Record Language spoken at home
Does the child/young person have any disability? ☐ Yes ☐ No ☐ N/A
Record details of any disabilities
Does the child/young person attend school? ☐ Yes ☐ No ☐ N/A
Record name of school, address and phone number
Care arrangements/Legal Status
☐ Lives with Parent/s (no parental conditions) ☐ Lives with Parent/s (with
conditions: (please specify)
☐ Under the care of the Minister (please specify)
☐ Other (please specify)
Parents/Carers/Significant Others Details
Person 1

Risk of Significant Harm (RoSH) Report
Name
Date of Birth / Age
Relationship to child/young person
Address
Phone
Gender ☐ Male ☐ Female
Does the person need an Interpreter: ☐ Yes ☐ No ☐ N/A
Record Language spoken at home
Does the person have any disability? ☐ Yes ☐ No ☐ N/A
Record details of any disabilities
Person 2
Name
Date of Birth / Age
Relationship to child/young person
Address
Phone
Gender ☐ Male ☐ Female
Does the person need an Interpreter: ☐ Yes ☐ No ☐ N/A
Record Language spoken at home
Does the person have any disability? ☐ Yes ☐ No ☐ N/A
Record details of any disabilities
Person 3
Name

Risk of Significant Harm (RoSH) Report
Date of Birth / Age
Relationship to child/young person
Address
Phone
Gender ☐ Male ☐ Female
Does the person need an Interpreter: ☐ Yes ☐ No ☐ N/A
Record Language spoken at home
Does the person have any disability? ☐ Yes ☐ No ☐ N/A
Record details of any disabilities
Person 4
Name
Date of Birth / Age
Relationship to child/young person
Address
Phone
Gender ☐ Male ☐ Female
Does the person need an Interpreter: ☐ Yes ☐ No ☐ N/A
Record Language spoken at home
Does the person have any disability? ☐ Yes ☐ No ☐ N/A
Record details of any disabilities
Risk of Significant Harm Information
Risk of Significant Harm Identified
☐ Physical Abuse ☐ Neglect ☐ Sexual Abuse ☐ Psychological Harm ☐
Danger to Self or Others

Risk of Significant Harm (RoSH) Report
☐ Domestic and Family Violence ☐ Cumulative Harm ☐ Homelessness ☐ Other
(please specify
Details of the Significant Harm
Additional comments
Reporter details
Name
Position
Phone
Email
Online Mandatory Reporter Guide (MRG) accessed
☐ Yes ☐ No ☐ N/A
Recommended Response from MRG [Record Outcome from MRG]