W.A.T.C.H. Child Assessment Tool

This form is an online tool to help you gather key components before making an official child abuse report. Please refer to our WATCH Assessment Tool Training for more details if needed. Please note that most states require mandated reporters to file a report for any concerns. This tool does NOT make a report for you. This tool is to help you assess the current risk level and to gather pertinent information in one place so you can make an effective report with your local authorities.

To Find Your State Reporting Phone Number:

Go to: https://www.childwelfare.gov/organizations/?CWIGFunctionsaction=rols:main.dspList&rolType=Custom&RS_ID=5
Find Your State
Complete this Form (copy will be emailed to you)
Call 800 Number Listed to Make Your Report
Refer to this Form During You Call and Forward to the Acting Investigator Assigned

Reporter's Name *

First

Last

Are you a state mandated reporter?

Are you a state mandated reporter?

Reporter's Phone *

Reporter's Email *

W.A.T.C.H. ASSESSMENT TOOL

Please respond to each assessment step below to the best of your ability. One answer per column is needed to determine if the child is at-risk or in-danger.

Layout

AT-RISK

IN-DANGER

NONE

W – WITNESS *

Is Abuse of Any Form Suspected?
Did You Witness Neglect, Physical, or Sexual Abuse?
None

A – ASSESS *

Is the Situation Dysfunctional?
Are there Marks on Child or Did they Make a Statement?
None

T – THREAT *

Does the Child Have Other Caring Adults Active in Their Lives?
Were Any Threatening Comments or Actions Made Towards the Child?
None

C – CONFIRMATION *

Are Subtle Indicators Present, but there is No Evidence to Support?
Is there Evidence or Indicators Present?
None

H – HOLES *

Are there Minor Holes/Discrepancies in Their Story?
Are there Major Holes/Discrepancies in Their Story?
None

An official report may not be needed. Please review your answers above and training. *

An official report may not be needed. Please review your answers above and training.

This is based on your answers not meeting a minimum of 2 at-risk or 1 in-danger responses above.

POWER OF ONE SOLUTION MODEL

List here the child’s specified “safe adults”. Do not automatically add names to this list. Only list the names of adults that the child says “makes them feel safe”.

Who are the Child's Listed SAFE Adults?

Include Name, Relation/Connection & Contact Number

5 Ws INFORMATION GATHERING TOOL

Please complete the answers below to the best of your ability. The bottom of this form will have a notes section to provide additional information.

WHAT Happened? *

What is the child’s current condition? What happened? What was said? What was seen? What was found? What evidence is available? What signs are present? What is the concern? 💡Pro Tip: Provide FACTS not suspensions or opinions.

WHEN Did it Happen? *

When did it happen? When did you become aware? When have you seen the child? When will you see the child next?💡Pro Tip: Save key dates to your cell phone calendar for quick reference.

WHO is Involved? *

Who is the child? Who cares or lives with the child? Other children involved? Who is suspected of harming the child? Who has access? Who can corroborate? 💡Pro Tip: Refrain from making any derogatory remarks about any person involved.

WHERE is the Child? *

Where does the child live? Where does the child go to school? Where have you interacted with the child? Where is the child now? 💡Pro Tip: Provide addresses when available. Also info about any relatives or close friends.

WHY are You Making This Report?

What information doesn’t seem to make sense? What are your concerns?

ADDITIONAL INFORMATION & EVIDENCE

Is there a change that is imminent (days) which would increase the child's danger level? *

Yes
No
Don’t Know

Often this is due to a child moving or a change in custody, etc.

Has the abuse been reported previously thru official child abuse hotlines or police? *

Yes
No
Don’t Know

Is the child currently in foster care? *

Yes
No
Don’t Know

Is there any supporting evidence available?

Please check all types of evidence you have available to submit to authorities when making an official report. These items are NOT required to make a report.

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Any additional pertinent information?

Please provide pertinent details only and be as brief as possible while providing useful information.

Acknowledge *

I acknowledge & understand that this online tool is solely for gathering information and NOT for submitting an official report of abuse. I understand that upon completion that my completed form is for my personal reference purposes.