Suspected Child Abuse Report Completed Form Examples and Samples

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Completed Suspected Child Abuse Report form based on teacher's observation notes

Source document used: Teacher Incident Narrative

Date: February 14, 2026. From: Sarah Jenkins, Lead Kindergarten Teacher, Maplewood Elementary. Subject: Incident Report regarding Leo Miller (DOB 09/12/2020). I am writing this incident report following a conversation with the school principal earlier today. After my call to the Child Protective Hotline on February 13, 2026, at 4:15 PM (Confirmation ID: 99284-B), I am filing this formal follow-up. During playtime, I noticed bruising on Leo's upper arms that looked like finger marks. When I asked him about it, he became visibly upset and mentioned that his father, David Miller, had 'grabbed him hard' for spilling milk at their home on 422 Oak Street, Springfield, IL 62704. I am the lead teacher for his class and have been working with him for six months. I have informed the school administration of these concerns. I have not discussed this report with the family, but I am willing to share the nature of my concerns if requested by the department. I am deeply worried about Leo's safety at home, though he currently seems stable at school. I also want to note that his younger brother, Sam Miller (DOB 05/22/2023), is also a student here, but I have not observed any similar injuries on him. This is the first time I have reported concerns regarding this family. I am filing this report in my professional capacity as a mandated reporter to ensure Leo is protected.