Fillable New-hire-mandated-reporter February 14, 2001

Fill Online, Printable, Fillable, Blank New-hire-mandated-reporter February 14, 2001 Form

Use Fill to complete blank online CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

New-hire-mandated-reporter February 14, 2001

On average this form takes 1 minutes to complete

The New-hire-mandated-reporter February 14, 2001 form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 3 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University Channel Islands

BROWSE CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
EXECUTIVE ORDER 1083
ATTACHMENT A
Page 1 of 2
ACKNOWLEDGEMENT OF MANDATED REPORTER STATUS
AND LEGAL DUTY TO REPORT CHILD ABUSE AND NEGLECT
California law requires certain people to report known or suspected child abuse or neglect. For purposes of Executive
Order 1083, which implements California law, you are such a person, known in the law as a “mandated reporter.” The
law requires that you, as a mandated reporter, sign this statement that you know your legal reporting obligations,
summarized below, and will comply with them.
The definition of mandated reporter (Penal Code § 11165.7), along with the law describing your reporting obligations
(Penal Code § 11166) and the law describing the content of reports and the confidentiality of those who report (Penal
Code § 11167) is provided in Attachment C to CSU Executive Order 1083. The Executive Order and all its attachments are
available at
http://calstate.edu/eo/EO-1083.html.
WHEN REPORTING ABUSE IS REQUIRED
As a mandated reporter, whenever in your professional capacity or within the scope of your employment you have
knowledge of or observe a person under the age of 18 years whom you know or reasonably suspect has been the victim
of child abuse or neglect, you must report the suspected incident (Penal Code § 11166).
MANDATED REPORTING COORDINATOR
Each campus has a Mandated Reporting Coordinator (Coordinator), who is available to assist you and other mandated
reporters in performing their duties. Your Coordinator is [name], who can be reached at [email] and [phone no.]. The
Coordinator can help with identifying whether there is a reasonable suspicion that abuse has occurred and how to
report it, as well as provide you with appropriate resources.
PROCEDURE FOR REPORTING
To make a report, you must use the following procedure:
• Immediately, or as soon as practically possible, contact the campus police by telephone.
• Within 36 hours of receiving the information concerning the incident prepare a written report using the form
provided in Attachment D and send, fax or electronically transmit the report to the campus police (Penal Code §
11166).
The Coordinator can help you fill out the incident form.
The CSU encourages, but does not require, mandated reporters to also report suspected child abuse or neglect to their
supervisors. Reporting to a supervisor, a coworker, or other person shall not be a substitute for making a mandated
report to the agencies listed above.
ABUSE THAT MUST BE REPORTED
Physical injury inflicted by other than accidental means on a child (Penal Code § 11165.6).
Sexual abuse meaning sexual assault or sexual exploitation of a child (Penal Code § 11165.1).
Neglect meaning the negligent treatment or maltreatment of a child by a parent or caretaker under circumstances
indicating harm or threatened harm to the child’s health or welfare (Penal Code § 11165.2).
Willful harming or injuring or endangering a child meaning a situation in which any person inflicts, or willfully causes or
permits a child to suffer, unjustifiable physical pain or mental suffering, or causes or permits a child to be placed in a
situation in which the child or child’s health is endangered (Penal Code § 11165.3).
EXECUTIVE ORDER 1083
ATTACHMENT A
Page 2 of 2
Unlawful corporal punishment or injury willfully inflicted upon a child and resulting in a traumatic condition
(Penal Code § 11165.4).
WHAT IS NOT CHILD ABUSE?
The law does not consider the following child abuse for reporting purposes:
• Corporal punishment that is not cruel or inhumane or does not result in a traumatic condition
• Injuries caused by two children fighting during a mutual altercation (Penal Code § 11165.4)
• An injury caused by reasonable and necessary force used by a peace officer acting within the course and scope
of his or her employment (Penal Code § 11165.6)
• Reasonable and necessary force used by public school officials to quell a disturbance threatening physical injury
to person or damage to property (Penal Code § 11165.4)
• Voluntary sexual conduct between minors
• Not receiving medical treatment for religious reasons (Penal Code § 1165.2(b))
• An informed and appropriate medical decision made by a parent or guardian after consultation with a physician
who has examined the child (Penal Code § 11165.2(b))
IMMUNITY AND CONFIDENTIALITY OF REPORTER
No mandated reporter shall be civilly or criminally liable for any report required or authorized by law (Penal Code §
11172(a)). The identity of a mandated reporter who makes a report, and the report itself, is confidential and disclosed
only among appropriate agencies (Penal Code §§ 11167(d)(1)).
PENALTY FOR FAILURE TO REPORT ABUSE
A mandated reporter who fails to make a required report is guilty of a misdemeanor punishable by up to six months in
jail, a fine of $1,000, or both. Any mandated reporter who willfully fails to report abuse or neglect, or any administrator
or supervisor who impedes or inhibits a report of abuse, where that abuse results in death or great bodily injury, shall be
punished by up to one year in jail, a fine of $5,000, or both.
COPY OF THE LAW
I acknowledge being provided with copies of Penal Code sections 11165.7, 11166, and 11167.
ACKNOWLEDGEMENT OF RESPONSIBILITY
I have read the above statement and will comply with the applicable reporting requirements.
Employee’s Name: _________________________________ Dept.: __________________
Signature: ________________________________________ Date: ___________________
Enclosed are the following attachments to CSU Executive Order 1083
Attachment A [THIS ACKNOWLEDGEMENT]
Attachment B (Certificate of Training Completion)
Attachment C (Copy of Penal Code §§ 11165.7, 11166, and 11167)
Attachment D (Form SS 8572, Suspected Child Abuse Report form)
NOTE: The original signed version of this Acknowledgement (Attachment A) as well as Attachment B should be retained
in the Employee’s Official Personnel File. The Employee must be given a copy.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

New-hire-mandated-reporter February 14, 2001

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document