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Tip Sheet: Keep a Journal of Warning Signs

If you are concerned about the safety of a child, we encourage you to trust your gut feelings. Sometimes vague feelings of discomfort or the sense that "something just isn’t right" can be an indication that something less visible is occurring in the background. Please take time to explore the situation further. Use this form to keep track of the behaviors that concern you. You can use this information to then talk with others about what you've witnessed.

Date of observed behavior(s):

_________________________________________________

Child’s name & age if known:

_______________________________________________________________

Name of adult, teen or child at risk to abuse, or suspected (if known):

_______________________________________________________________

Time of day: _______________________________________________________________

Describe activity and people involved (e.g., nap time with siblings, games at family picnic):

_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

 

Describe behaviors as specifically as you can (e.g., what you saw and heard):

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Note when you first noticed the behavior, how often you have seen it, and why you are concerned:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Note anything you said, or did and what happened:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________


Share Prevention Tip Sheets in Your Community

We encourage you to print and share these tip sheets in your family and community.  Our tip sheets are licensed under the Creative Commons, which allows you to reproduce them as long as you follow these Guidelines. Please contact us about permissions and to tell us how you plan to put our resources to work. You can also buy high quality, print versions of selected tip sheets in bulk in our Store.

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