Minors Safety Concern Reporting Form

This form should be completed when someone knows, suspects, or receives information that the health or safety of a minor, defined under Massachusetts law as an individual under the age of 18, may be at risk. Concerns may include a specific incident that occurred on/off campus, a suspicion of abuse or neglect, or a suspicion that a minor may be a threat to themselves or to others.

Instructions:

After you fill out this Webform and press "Submit" it is automatically sent to the appropriate offices, including the Boston University Police Department (BUPD), the Office of Risk Management, the Human Resources Office, and the Compliance Services Office.

When should this form be used?

Who is required to report concerns of child safety?

- Any University faculty, staff, student, or volunteer participating in a University Activity

- Any owner/operator, employee, volunteer, or agent of a Third-Party Program

- Mandated reporters, under M.G.L. c. 119, § 51A

- Campus Security Authorities, under the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act

- Title IX Coordinator and Deputy Coordinators

Who to Contact?

Members of the BU community with concerns regarding child safety should direct their concerns to the Boston University Police Department (BUPD) at 617-353-2121 or bupolice@bu.edu. Anyone may contact Department of Children & Families directly using the Child-at-Risk Hotline any time of the day or night at 800-792-5200.

What if a victim requests confidentiality?

All instances involving a threat to the health or safety of a minor must be reported, regardless of the desire of the minor.

What should you do if you feel a minor is in immediate danger?

If you fear an immediate threat to the minor, contact BUPD immediately at 617-353-2121. If you are off the main campus, call 911 or local law enforcement. Remain with the minor until help arrives.

What happens with the information I provide?

The report will be submitted to the Boston University Police Department for review and the appropriate parties will be notified.

More Information:

Information about steps for reporting an incident involving minors can be found here: https://www.bu.edu/protection-of-minors/reporting/, or the University’s Protection of Minors efforts generally, can be found on the BU Protection of Minors website: (https://www.bu.edu/protection-of-minors/).

Details of Your Minors Safety Concern

Location of Incident:(Required)

On Campus

Off Campus

Type of Concern (potential or observed):(Required)

Reporter's Information

The Reporter and minor can be different people. The Reporter has the option to not self-identify on this form.

Date of Report:(Required)

Reporter's Name (if different than minor involved):(Required)

First Last

Reporter's Affiliation to Boston University:(Required)

Please choose the role that best describes your relationship to the University.

Reporter's Phone Number:(Required)

Best Time to Call:(Required)

Reporter's Email:

Minor's Information (if Reporter and Minor are different people)

Minor's Name:(Required)

First Last

Minor's Program or Activity:(Required)

Minor's Phone Number (if available):

Minor's Email (if available):

Parent/Guardian Information

Parent/Guardian Phone Number (if available):(Required)

Parent/Guardian Email:(Required)

Other Parties Involved

Name (if known):

First Last

Affiliation to Boston University:(Required)

Please choose the role that best describes their relationship to the University

Incident Information

Date of Incident:(Required)

Time of Incident:(Required)

Location of Incident:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Brief Description of the Incident(Required)

Other Reports

Have you or has anyone else reported this incident to another department or office (for example: Massachusetts Department of Children and Families, local police, Sexual Assault Response and Prevention Center, Dean of Students, Residence Life, the Equal Opportunity Office, or Human Resources)?(Required)

Yes

If yes, please list department/office or agencies notified(Required)

Additional Information

Please provide any additional details you feel are pertinent to the situation being reported that are not captured in the information provided in the form above.

Additional Information