This is the readable version of the official PDF. The official PDF is the one to fill in and return.
Amity School District
Code: JHFE-AR(3)
Adopted: 03/07/18
Revised/Readopted: 10/10/18
The Department of Human Services (DHS) or a law enforcement agency has the authority to conduct an investigation of a report of child abuse on school premises according to Oregon Revised Statute (ORS) 419B.045. The school administrator must be notified that the investigation is to take place, unless the administrator is a subject of the investigation. The investigator is not required to reveal information about the investigation to the school as a condition of conducting the investigation.
After the investigator provides adequate identification, school staff shall allow access to the child and provide a private space for conducting the interview. The investigator shall be advised by a school administrator or a school staff member of a child’s relevant disabling conditions, if any, prior to any interview with the child. The school administrator or designee may, at the investigator’s discretion, be present to facilitate the investigation.
School staff may only notify DHS, the law enforcement agency or school employees that are necessary to enable the investigation. School staff may not notify any other persons, including the child’ parent(s) or guardian(s).
Investigator Name (Printed): (blank)
Name of Agency: (blank)
Name of Worker’s/Investigator’s Supervisor: (blank)
Supervisor Contact Information: (blank)
Investigator Position and Badge or ID Number: (blank)
Student Name: (blank)
School: (blank)
Investigator Signature: (blank) Date: (blank)
☐ Investigator refused to sign. District staff should not deny entry based on refusal to sign.
For completion by district staff#
Name of Administrator Notified: (blank)
☐ Student not available for interview ☐ Student refused to be interviewed ☐ Administrator participated in interview
Name of Office Staff Involved: (blank)
Name of Participating Administrator: (blank)
This form should be placed in a separate secure file and not in the student’s file.