STATEMENT ACKNOWLEDGING REQUIREMENT

TO REPORT CHILD ABUSE AND NEGLECT

State law requires that any person who enters into employment on and after January 1, 1985, who is a "mandated reporter” of child abuse and neglect, prior to commencing employment shall sign a statement that he or she has knowledge of the provisions of section §11166 of the Penal Code and will comply with its provisions.

You have been identified as a "mandated reporter" within the meaning of the statute. The definition of mandated reporter (Penal Code, §11165.7) is attached, along with the provisions for your reporting obligations (Penal Code, §11166)*, and the provisions for the content of reports and the confidentiality of those who report (Penal Code, §11167).

Section §11166 of the Penal Code requires any "mandated reporter" who has knowledge of or observes a child in his or her professional capacity, or within the scope of his or her employment, who he or she knows or reasonably suspects has been the victim of child abuse or neglect to report the known or suspected instance of child abuse or neglect to a child protective agency immediately or as soon as practically possible by telephone and to prepare and send a written report thereof within 36 hours of receiving the information concerning the incident.

Any person who fails to report an instance of child abuse or neglect which he or she knows to exist or reasonably should know to exist, as required, is guilty of a misdemeanor which is punishable by confinement in the county jail for a term not to exceed six months or by a fine of not more than one thousand dollars ($1,000) or by both imprisonment and fine.

The law also provides that no mandated reporter shall be civilly or criminally liable for any report required or authorized, and this immunity shall apply even if the mandated reporter acquired the knowledge or reasonable suspicion of child abuse or neglect outside of his or her professional capacity or outside the scope of his or her employment.

Any other person reporting a known or suspected instance of child abuse or neglect shall not incur civil or criminal liability as a result of any report unless it can be proven that a false report was made and the person knew that the report was false or was made with reckless disregard of the truth or falsity of the report (Penal Code §11172).

I have read the above statement and will comply with the applicable reporting requirements.

Employee’s Name: ______Department: ______

Signature: ______Date: ______

Note: The original copy of this signed document should be sent to Human Resources and maintained on file.

*If you have knowledge of or observe a child whom you know or reasonably suspect has been abused, you must make a report to Child Protective Services immediately, or as soon as practically possible by phone (1-800-540-4000). A written report to the Department of Justice must also be forwardedwithin 36 hours; Child Abuse Reporting Forms can be completed by accessing the Department of Children & Family Services website A draft copy of the reporting form is also available in the Patient Care Center - Administration, Medical Center – 2ndFloor, or Human Resources Lobby.

Attachments:

Penal Code §1165.7, §11166, §11166.5, §11167 and §11172

To review a complete copy of the California Penal Code regarding Child Abuse Reporting Requirements, please visit website

CALIFORNIA PENAL CODES – CHILD ABUSE REPORTING REQUIREMENTS

Penal Code 11165.7

(a) As used in this article, "mandated reporter" isdefined as any of the following:

(1) A teacher.

(2) An instructional aide.

(3) A teacher's aide or teacher's assistant employed by any publicor private school.

(4) A classified employee of any public school.

(5) An administrative officer or supervisor of child welfare andattendance, or a certificated pupil personnel employee of any publicor private school.

(6) An administrator of a public or private day camp.

(7) An administrator or employee of a public or private youthcenter, youth recreation program, or youth organization.

(8) An administrator or employee of a public or privateorganization whose duties require direct contact and supervision ofchildren.

(9) Any employee of a county office of education or the State

Department of Education, whose duties bring the employee into contactwith children on a regular basis.

(10) A licensee, an administrator, or an employee of a licensedcommunity care or child day care facility.

(11) A Head Start program teacher.

(12) A licensing worker or licensing evaluator employed by alicensing agency as defined in Section 11165.11.

(13) A public assistance worker.

(14) An employee of a child care institution, including, but notlimited to, foster parents, group home personnel, and personnel ofresidential care facilities.

(15) A social worker, probation officer, or parole officer.

(16) An employee of a school district police or securitydepartment.

(17) Any person who is an administrator or presenter of, or acounselor in, a child abuse prevention program in any public orprivate school.

(18) A district attorney investigator, inspector, or local childsupport agency caseworker unless the investigator, inspector, orcaseworker is working with an attorney appointed pursuant to Section317 of the Welfare and Institutions Code to represent a minor.

(19) A peace officer, as defined in Chapter 4.5 (commencing withSection 830) of Title 3 of Part 2, who is not otherwise described inthis section.

(20) A firefighter, except for volunteer firefighters.

(21) A physician, surgeon, psychiatrist, psychologist, dentist,resident, intern, podiatrist, chiropractor, licensed nurse, dentalhygienist, optometrist, marriage, family and child counselor,clinical social worker, or any other person who is currently licensedunder Division 2 (commencing with Section 500) of the Business andProfessions Code.

(22) Any emergency medical technician I or II, paramedic, or otherperson certified pursuant to Division 2.5 (commencing with Section1797) of the Health and Safety Code.

(23) A psychological assistant registered pursuant to Section 2913of the Business and Professions Code.

(24) A marriage, family, and child therapist trainee, as definedin subdivision (c) of Section 4980.03 of the Business and ProfessionsCode.

(25) An unlicensed marriage, family, and child therapist internregistered under Section 4980.44 of the Business and ProfessionsCode.

(26) A state or county public health employee who treats a minorfor venereal disease or any other condition.

(27) A coroner.

(28) A medical examiner, or any other person who performsautopsies.

(29) A commercial film and photographic print processor, asspecified in subdivision (e) of Section 11166. As used in thisarticle, "commercial film and photographic print processor" means anyperson who develops exposed photographic film into negatives,slides, or prints, or who makes prints from negatives or slides, forcompensation. The term includes any employee of such a person; itdoes not include a person who develops film or makes prints for apublic agency.

(30) A child visitation monitor. As used in this article, "childvisitation monitor" means any person who, for financial compensation,acts as monitor of a visit between a child and any other person whenthe monitoring of that visit has been ordered by a court of law.

(31) An animal control officer or humane society officer. For thepurposes of this article, the following terms have the followingmeanings:

(A) "Animal control officer" means any person employed by a city,county, or city and county for the purpose of enforcing animalcontrol laws or regulations.

(B) "Humane society officer" means any person appointed oremployed by a public or private entity as a humane officer who isqualified pursuant to Section 14502 or 14503 of the CorporationsCode.

(32) A clergy member, as specified in subdivision (d) of Section11166. As used in this article, "clergy member" means a priest,minister, rabbi, religious practitioner, or similar functionary of achurch, temple, or recognized denomination or organization.

(33) Any custodian of records of a clergy member, as specified inthis section and subdivision (d) of Section 11166.

(34) Any employee of any police department, county sheriff'sdepartment, county probation department, or county welfaredepartment.

(35) An employee or volunteer of a Court Appointed SpecialAdvocate program, as defined in Rule 1424 of the California Rules ofCourt.

(36) A custodial officer as defined in Section 831.5.

(37) Any person providing services to a minor child under Section12300 or 12300.1 of the Welfare and Institutions Code.

(38) An alcohol and drug counselor. As used in this article, an"alcohol and drug counselor" is a person providing counseling,therapy, or other clinical services for a state licensed or certifieddrug, alcohol, or drug and alcohol treatment program. However,alcohol or drug abuse, or both alcohol and drug abuse, is not in andof itself a sufficient basis for reporting child abuse or neglect.

(b) Except as provided in paragraph (35) of subdivision (a),volunteers of public or private organizations whose duties requiredirect contact with and supervision of children are not mandatedreporters but are encouraged to obtain training in the identificationand reporting of child abuse and neglect and are further encouragedto report known or suspected instances of child abuse or neglect toan agency specified in Section 11165.9.

(c) Employers are strongly encouraged to provide their employeeswho are mandated reporters with training in the duties imposed bythis article. This training shall include training in child abuse andneglect identification and training in child abuse and neglectreporting. Whether or not employers provide their employees withtraining in child abuse and neglect identification and reporting, theemployers shall provide their employees who are mandated reporterswith the statement required pursuant to subdivision (a) of Section11166.5.

(d) School districts that do not train their employees specifiedin subdivision (a) in the duties of mandated reporters under thechild abuse reporting laws shall report to the State Department ofEducation the reasons why this training is not provided.

(e) Unless otherwise specifically provided, the absence oftraining shall not excuse a mandated reporter from the duties imposedby this article.

(f) Public and private organizations are encouraged to providetheir volunteers whose duties require direct contact with andsupervision of children with training in the identification andreporting of child abuse and neglect.

Penal Code 11166

(a) Except as provided in subdivision (d), and in Section11166.05, a mandated reporter shall make a report to an agencyspecified in Section 11165.9 whenever the mandated reporter, in hisor her professional capacity or within the scope of his or heremployment, has knowledge of or observes a child whom the mandatedreporter knows or reasonably suspects has been the victim of childabuse or neglect. The mandated reporter shall make an initial reportto the agency immediately or as soon as is practicably possible bytelephone and the mandated reporter shall prepare and send, fax, orelectronically transmit a written follow-up report thereof within 36hours of receiving the information concerning the incident. Themandated reporter may include with the report any non-privilegeddocumentary evidence the mandated reporter possesses relating to theincident.

(1) For purposes of this article, "reasonable suspicion" meansthat it is objectively reasonable for a person to entertain asuspicion, based upon facts that could cause a reasonable person in alike position, drawing, when appropriate, on his or her training andexperience, to suspect child abuse or neglect. "Reasonable suspicion"does not require certainty that child abuse or neglect has occurrednor does it require a specific medical indication of child abuse orneglect; any "reasonable suspicion" is sufficient. For the purpose ofthis article, the pregnancy of a minor does not, in and of itself,constitute a basis for a reasonable suspicion of sexual abuse.

(2) The agency shall be notified and a report shall be preparedand sent, faxed, or electronically transmitted even if the child hasexpired, regardless of whether or not the possible abuse was a factorcontributing to the death, and even if suspected child abuse wasdiscovered during an autopsy.

(3) Any report made by a mandated reporter pursuant to thissection shall be known as a mandated report.

(b) If after reasonable efforts a mandated reporter is unable tosubmit an initial report by telephone, he or she shall immediately oras soon as is practicably possible, by fax or electronictransmission, make a one-time automated written report on the formprescribed by the Department of Justice, and shall also be availableto respond to a telephone follow-up call by the agency with which heor she filed the report. A mandated reporter who files a one-timeautomated written report because he or she was unable to submit aninitial report by telephone is not required to submit a writtenfollow-up report.

(1) The one-time automated written report form prescribed by theDepartment of Justice shall be clearly identifiable so that it is notmistaken for a standard written follow-up report. In addition, theautomated one-time report shall contain a section that allows themandated reporter to state the reason the initial telephone call wasnot able to be completed. The reason for the submission of theone-time automated written report in lieu of the procedure prescribedin subdivision (a) shall be captured in the Child WelfareServices/Case Management System (CWS/CMS). The department shall workwith stakeholders to modify reporting forms and the CWS/CMS as isnecessary to accommodate the changes enacted by these provisions.

(2) This subdivision shall not become operative until the CWS/CMSis updated to capture the information prescribed in this subdivision.

(3) This subdivision shall become inoperative three years afterthis subdivision becomes operative or on January 1, 2009, whicheveroccurs first.

(4) On the inoperative date of these provisions, a report shall besubmitted to the counties and the Legislature by the Department ofSocial Services that reflects the data collected from automatedone-time reports indicating the reasons stated as to why theautomated one-time report was filed in lieu of the initial telephonereport.

(5) Nothing in this section shall supersede the requirement that amandated reporter first attempt to make a report via telephone, orthatagencies specified in Section 11165.9 accept reports frommandated reporters and other persons as required.

(c) Any mandated reporter who fails to report an incident of knownor reasonably suspected child abuse or neglect as required by thissection is guilty of a misdemeanor punishable by up to six monthsconfinement in a county jail or by a fine of one thousand dollars($1,000) or by both that imprisonment and fine. If a mandatedreporter intentionally conceals his or her failure to report anincident known by the mandated reporter to be abuse or severe neglectunder this section, the failure to report is a continuing offenseuntil an agency specified in Section 11165.9 discovers the offense.

(d) (1) A clergy member who acquires knowledge or a reasonablesuspicion of child abuse or neglect during a penitentialcommunication is not subject to subdivision (a). For the purposes ofthis subdivision, "penitential communication" means a communication,intended to be in confidence, including, but not limited to, asacramental confession, made to a clergy member who, in the course ofthe discipline or practice of his or her church, denomination, ororganization, is authorized or accustomed to hear thosecommunications, and under the discipline, tenets, customs, orpractices of his or her church, denomination, or organization, has aduty to keep those communications secret.

(2) Nothing in this subdivision shall be construed to modify orlimit a clergy member's duty to report known or suspected child abuseor neglect when the clergy member is acting in some other capacitythat would otherwise make the clergy member a mandated reporter.

(3) (A) On or before January 1, 2004, a clergy member or anycustodian of records for the clergy member may report to an agencyspecified in Section 11165.9 that the clergy member or any custodianof records for the clergy member, prior to January 1, 1997, in his orher professional capacity or within the scope of his or heremployment, other than during a penitential communication, acquiredknowledge or had a reasonable suspicion that a child had been thevictim of sexual abuse that the clergy member or any custodian ofrecords for the clergy member did not previously report the abuse toan agency specified in Section 11165.9. The provisions of Section11172 shall apply to all reports made pursuant to this paragraph.

(B) This paragraph shall apply even if the victim of the known orsuspected abuse has reached the age of majority by the time therequired report is made.

(C) The local law enforcement agency shall have jurisdiction toinvestigate any report of child abuse made pursuant to this paragrapheven if the report is made after the victim has reached the age ofmajority.

(e) Any commercial film and photographic print processor who hasknowledge of or observes, within the scope of his or her professionalcapacity or employment, any film, photograph, videotape, negative,or slide depicting a child under the age of 16 years engaged in anact of sexual conduct, shall report the instance of suspected childabuse to the law enforcement agency having jurisdiction over the caseimmediately, or as soon as practicably possible, by telephone andshall prepare and send, fax, or electronically transmit a writtenreport of it with a copy of the film, photograph, videotape,negative, or slide attached within 36 hours of receiving theinformation concerning the incident. As used in this subdivision,"sexual conduct" means any of the following:

(1) Sexual intercourse, including genital-genital, oral-genital, anal-genital, or oral-anal, whether between persons of the same oropposite sex or between humans and animals.

(2) Penetration of the vagina or rectum by any object.

(3) Masturbation for the purpose of sexual stimulation of theviewer.

(4) Sadomasochistic abuse for the purpose of sexual stimulation ofthe viewer.

(5) Exhibition of the genitals, pubic, or rectal areas of anyperson for the purpose of sexual stimulation of the viewer.

(f) Any mandated reporter who knows or reasonably suspects thatthe home or institution in which a child resides is unsuitable forthe child because of abuse or neglect of the child shall bring thecondition to the attention of the agency to which, and at the sametime as, he or she makes a report of the abuse or neglect pursuant tosubdivision (a).

(g) Any other person who has knowledge of or observes a child whomhe or she knows or reasonably suspects has been a victim of childabuse or neglect may report the known or suspected instance of childabuse or neglect to an agency specified in Section 11165.9. Forpurposes of this section, "any other person" includes a mandatedreporter who acts in his or her private capacity and not in his orher professional capacity or within the scope of his or heremployment.

(h) When two or more persons, who are required to report, jointlyhave knowledge of a known or suspected instance of child abuse orneglect, and when there is agreement among them, the telephone reportmay be made by a member of the team selected by mutual agreement anda single report may be made and signed by the selected member of thereporting team. Any member who has knowledge that the memberdesignated to report has failed to do so shall thereafter make thereport.

(i) (1) The reporting duties under this section are individual,and no supervisor or administrator may impede or inhibit thereporting duties, and no person making a report shall be subject toany sanction for making the report. However, internal procedures tofacilitate reporting and apprise supervisors and administrators ofreports may be established provided that they are not inconsistentwith this article.