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Reference code
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{{data.isCollab?\"\":\"When you saved your form you should have been provided a reference code.\"}}

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Security question
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Your answer to this question must match the information you previously provided.

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Security Question
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Please review your security question and answer. This question must be correctly answered to re-open the form.

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"mandatory": false, "noData": true, "offset": { "lg": 0, "md": 0, "sm": 0, "xs": 0 }, "overrideParentUsRule": false, "path": "", "pathContext": "", "properties": { "floatRight": false }, "repeatingData": false, "span": { "lg": 12, "md": 12, "sm": 12, "xs": 12 }, "type": "text-display-custom" } ], [ { "_component": "saveComponent", "clearHidden": "", "entityPath": "", "exclude": false, "excludeRowData": false, "htmlLabel": "

Next steps

\n

You are required to complete these additional forms to finalize your request.

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\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please note that your saved form will expire on {{data.expiryDate}}.

\n
\n
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Send yourself a reminder email

\n

Enter your email address and we'll send you you instructions on how to return to your form.

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Check your email

\n\n

We've sent instructions to your email address ({{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.send_reminder_email}}) on how to return to the application when you are ready.

\n\n

If you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.

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OR

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Next steps

\n

You are required to complete these additional forms to finalize your request.

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\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please quote your reference code when enquiring about your submission.

\n
\n\n
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For your records

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OR

\n\n

Send yourself an email with a PDF copy of your form

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Check your email

\n\n

We've sent a copy of your submission to {{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.yourEmailAddress}}.

\n\n

If you didn't receive it or would like another copy, just select the option below.

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OR

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Phone: {{data.agencyPhone}}

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For the purpose of this form, references to \"child\" includes anyone under the age of 18 years.

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Call triple-zero (000) now before completing this form.

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Please seek support from FIRST Canberra or contact the Police.

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Contact police who investigate risk of significant harm outside the family environment. If you are worried about a parent’s capacity to protect the child/ren, please call Children, Youth and Families on 1300 556 729 to talk through your concern.

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Please contact the relevant state Child Protection Office:

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Support for expectant parents is also available:

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For more information, visit the Community Services website

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Where do you scale the situation at the moment on a scale of 0 - 10, where: *

\n\n

10 - means there have been some concerns for the child, but no more than any child in the community and there are people around making sure the child is okay.
\n0 - means I am so worried about the child, they have already been hurt or frightened and if something doesn’t change they could be seriously hurt or frightened again?

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"mandatoryMsg": "", "properties": { "helpText": "" } }, "expectedDateOfBirth": { "htmlLabel": "Expected DOB", "label": "Expected DOB", "mandatoryMsg": "", "properties": { "ariaLabel": "", "outputDelimiter": "-" } }, "expiryDate": { "htmlLabel": "Expiry Date", "label": "Expiry Date", "mandatoryMsg": "" }, "family": { "htmlLabel": "Is the person you believe is harming the child, the child's family member or guardian?", "label": "Is the person you believe is harming the child, the child's family member or guardian?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" }, { "label": "Unknown", "value": "Unknown~859650002" } ], "placeholder": "", "underHelpText": "" } }, "familyAndNetworkDetails": { "htmlLabel": "Family and network details", "label": "Family and network details", "mandatoryMsg": "", "properties": { "additionalText": 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"label": "Exposure to family violence", "mandatoryMsg": "", "properties": { "helpText": "" } }, "feecode": { "htmlLabel": "FeeCode", "label": "FeeCode", "mandatoryMsg": "" }, "floorSSB": { "htmlLabel": "Floor", "label": "Floor", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "floorSSB_2": { "htmlLabel": "Floor", "label": "Floor", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "followupdata": { "htmlLabel": "FollowUpData", "label": "FollowUpData", "mandatoryMsg": "" }, "followupdatasubmitdisplay": { "htmlLabel": "followupdata", "label": "followupdata", "mandatoryMsg": "" }, "fontAwesome6Brands": { "htmlLabel": "Font Awesome 6 Brands", "label": "Font Awesome 6 Brands", "mandatoryMsg": "" }, "fontAwesome6Free": { "htmlLabel": "Font Awesome 6 Free", "label": "Font Awesome 6 Free", "mandatoryMsg": "" }, "fontAwesome6Regular": { "htmlLabel": "Font Awesome 6 Regular", "label": "Font Awesome 6 Regular", "mandatoryMsg": "" }, "footer": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footerLinks": { "htmlLabel": "Footer Links", "label": "Footer Links", "mandatoryMsg": "" }, "footerLinksParsed": { "htmlLabel": "Footer Links Parsed", "label": "Footer Links Parsed", "mandatoryMsg": "" }, "footer_1": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footer_2": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footer_3": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footer_4": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footer_5": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footer_6": { "htmlLabel": "Footer", "label": "Footer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "footersBlock": { "htmlLabel": "Footers", "label": "Footers", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "formClassSetter": { "htmlLabel": "Form Class Setter", "label": "Form Class Setter", "mandatoryMsg": "" }, "formContainerCustom": { "htmlLabel": "", "label": "Form Container (Custom)", "mandatoryMsg": "" }, "formGlobalAlert": { "htmlLabel": "", "label": "Global Alert", "mandatoryMsg": "" }, "format": { "htmlLabel": "Format", "label": "Format", "mandatoryMsg": "" }, "format_2": { "htmlLabel": "Format", "label": "Format", "mandatoryMsg": "" }, "fullAddressAdult": { "htmlLabel": "Full Address Adult", "label": "Full Address Adult", "mandatoryMsg": "" }, "fullNamePersonResponsible": { "htmlLabel": "Full name", "label": "Full name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "gender": { "htmlLabel": "Gender", "label": "Gender", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Female", "value": "Female~2824a8a3-0ade-e711-8141-70106fa39b91" }, { "label": "Indeterminate", "value": "Indeterminate~e14566ee-8b23-e911-a975-000d3ae12afe" }, { "label": "Male", "value": "Male~2a24a8a3-0ade-e711-8141-70106fa39b91" }, { "label": "Non-Binary", "value": "Non-Binary~2f92e611-f43e-e911-a977-000d3ae12afe" }, { "label": "Unknown", "value": "Unknown~fa53d0ba-8b23-e911-a975-000d3ae12afe" } ], "placeholder": "", "underHelpText": "" } }, "genderPerson": { "htmlLabel": "Gender", "label": "Gender", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Female", "value": "Female~2824a8a3-0ade-e711-8141-70106fa39b91" }, { "label": "Indeterminate", "value": 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"geocode": { "htmlLabel": "Geocode", "label": "Geocode", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "geocodeArray": { "htmlLabel": "GeocodeArray", "label": "GeocodeArray", "mandatoryMsg": "" }, "geocodeArray_2": { "htmlLabel": "GeocodeArray", "label": "GeocodeArray", "mandatoryMsg": "" }, "geocode_2": { "htmlLabel": "Geocode", "label": "Geocode", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "giveDetails": { "htmlLabel": "Give details of who in the family you have spoken to, and what they said", "label": "Give details of who in the family you have spoken to, and what they said", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "givenName": { "htmlLabel": "First name", "label": "First name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "givenName_1": { "htmlLabel": "First name", "label": "First name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "givenName_2": { "htmlLabel": "First name", "label": "First name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "givenName_3": { "htmlLabel": "First name", "label": "First name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "givenName_4": { "htmlLabel": "First name", "label": "First name", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "gst_1": { "htmlLabel": "GST", "label": "GST", "mandatoryMsg": "" }, "happenedBefore": { "htmlLabel": "Has this happened before?", "label": "Has this happened before?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" }, { "label": "Unknown", "value": "Unknown~859650002" } ], "placeholder": "", "underHelpText": "" } }, "harmACT": { "htmlLabel": "Did the harm happen in the ACT?", "label": "Did the harm happen in the ACT?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" }, { "label": "Unknown", "value": "Unknown~859650002" } ], "placeholder": "", "underHelpText": "" } }, "haveYouTalked": { "htmlLabel": "Have you talked to anyone in the family or the child about your worries?", "label": "Have you talked to anyone in the family or the child about your worries?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" } ], "underHelpText": "" } }, "helpDialog": { "htmlLabel": "Help dialog", "label": "Help dialog", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "helpFeedbackForm": { "htmlLabel": "Online feedback form", "label": "Online feedback form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-globe" } }, "helpMakingReportConcerns": { "htmlLabel": "

For the purpose of this form, references to \"child\" includes anyone under the age of 18 years.

\n", "label": "For the purpose of this form, references to \"child\" includes anyone under the age of 18 years.", "mandatoryMsg": "" }, "helpNotACT": { "htmlLabel": "

Please contact the relevant state Child Protection Office:

\n", "label": "Please contact the relevant state Child Protection Office:\n\n New South Wales (NSW) - 13 21 11\n Northern Territory (NT) - 1800 700 250\n Queensland (QLD) - 1800 811 810\n South Australia (SA) - 13 14 78\n Tasmania (TAS) - 1800 000 123\n Western Australia (WA) - 1800 273 889\n Victoria - North Division - 1300 598 521, South Division - 1300 555 526, East Division - 1300 360 452, West Division - 1300 360 462, After hours 13 12 78", "mandatoryMsg": "" }, "helpPhone": { "htmlLabel": "13 22 81", "label": "13 22 81", "mandatoryMsg": "", "properties": { "fontawesome": "fa-phone" } }, "helpReporter": { "htmlLabel": "

It is helpful for Children, Youth and Families to know how to contact you if we need to clarify your concerns. If you do not wish to provide your contact number, you can contact Children, Youth and Families on 1300 556 729.

", "label": "It is helpful for Children, Youth and Families to know how to contact you if we need to clarify your concerns. If you do not wish to provide your contact number, you can contact Children, Youth and Families on 1300 556 729.", "mandatoryMsg": "" }, "helpTextCustom": { "htmlLabel": "

Call triple-zero (000) now before completing this form.

\n", "label": "Call triple-zero (000) now before completing this form.", "mandatoryMsg": "" }, "helpTextCustom_1": { "htmlLabel": "

Please seek support from FIRST Canberra or contact the Police.

\n", "label": "Please seek support from FIRST Canberra or contact the Police.", "mandatoryMsg": "" }, "helpTextCustom_2": { "htmlLabel": "

Contact police who investigate risk of significant harm outside the family environment. If you are worried about a parent’s capacity to protect the child/ren, please call Children, Youth and Families on 1300 556 729 to talk through your concern.

\n", "label": "Contact police who investigate risk of significant harm outside the family environment. If you are worried about a parent’s capacity to protect the child/ren, please call Children, Youth and Families on 1300 556 729 to talk through your concern.", "mandatoryMsg": "" }, "helpTextCustom_3": { "htmlLabel": "

Support for expectant parents is also available:

\n\n\n\n

For more information, visit the Community Services website

\n", "label": "Support for expectant parents is also available:\n\n\n\tChild and Family Centreat Gungahlin - 6207 0120\n\tChild and Family Centreat Tuggeranong - 6207 8228\n\tChild and Family Centreat West Belconnen - 6205 2904\n\tor visit Pregnancy, birth and early childhood services - Canberra Health Services\n\n\nFor more information, visit the Community Services website", "mandatoryMsg": "" }, "helpTextCustom_4": { "htmlLabel": "

Your answers to the following questions will help us to understand the child/ren and family situation.

\n", "label": "Your answers to the following questions will help us to understand the child/ren and family situation.", "mandatoryMsg": "" }, "helpTextDisplay": { "htmlLabel": "helptext", "label": "helptext", "mandatoryMsg": "" }, "helptextContent": { "htmlLabel": "Need help?", "label": "Need help?", "mandatoryMsg": "" }, "helptextPrefill": { "htmlLabel": "Helptext", "label": "Helptext", "mandatoryMsg": "" }, "howOfterYouSeeChild": { "htmlLabel": "How often do you see the child? When was the last time you saw the child?", "label": "How often do you see the child? When was the last time you saw the child?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "htmlDisplay": { "htmlLabel": "

Next steps

\n

You are required to complete these additional forms to finalize your request.

", "label": "Next steps\nYou are required to complete these additional forms to finalize your request.", "mandatoryMsg": "" }, "htmlDisplay_1": { "htmlLabel": "
\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please quote your reference code when enquiring about your submission.

\n
\n\n
\n", "label": "Your reference code is:\n\n\n\nPlease quote your reference code when enquiring about your submission.", "mandatoryMsg": "" }, "htmlDisplay_2": { "htmlLabel": "

OR

\n\n

Send yourself an email with a PDF copy of your form

\n", "label": "OR\n\nSend yourself an email with a PDF copy of your form", "mandatoryMsg": "" }, "htmlDisplay_3": { "htmlLabel": "

OR

", "label": "OR", "mandatoryMsg": "" }, "htmlDisplay_4": { "htmlLabel": "

Next steps

\n

You are required to complete these additional forms to finalize your request.

", "label": "Next steps\nYou are required to complete these additional forms to finalize your request.", "mandatoryMsg": "" }, "htmlDisplay_5": { "htmlLabel": "
\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please note that your saved form will expire on {{data.expiryDate}}.

\n
\n
\n", "label": "Your reference code is:\n\n\n\nPlease note that your saved form will expire on .", "mandatoryMsg": "" }, "htmlDisplay_7": { "htmlLabel": "

OR

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What is different today that makes this more of a worry?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "privacyContent": { "htmlLabel": "Privacy", "label": "Privacy", "mandatoryMsg": "" }, "privacyDialog": { "htmlLabel": "Privacy", "label": "Privacy", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "privacyPrefill": { "htmlLabel": "Privacy", "label": "Privacy", "mandatoryMsg": "" }, "privacyText": { "htmlLabel": "privacy", "label": "privacy", "mandatoryMsg": "" }, "puppeteer": { "htmlLabel": "Puppeteer", "label": "Puppeteer", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "quantity": { "htmlLabel": "Quantity", "label": "Quantity", "mandatoryMsg": "" }, "rawDate": { "htmlLabel": "RawDate", "label": "RawDate", "mandatoryMsg": "" }, "rawDate_1": { "htmlLabel": "RawDate", "label": "RawDate", "mandatoryMsg": "" }, "rawDate_2": { "htmlLabel": "RawDate", "label": "RawDate", "mandatoryMsg": "" }, "rawDate_3": { "htmlLabel": "RawDate", "label": "RawDate", "mandatoryMsg": "" }, "receiptcode": { "htmlLabel": "ReceiptCode", "label": "ReceiptCode", "mandatoryMsg": "" }, "receiptfooter_1": { "htmlLabel": "ReceiptFooter", "label": "ReceiptFooter", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "referenceCode_1": { "htmlLabel": "Reference code", "label": "Reference code", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "refferredToSupportService": { "htmlLabel": "Has the family been referred to a support service?", "label": "Has the family been referred to a support service?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" }, { "label": "Unknown", "value": "Unknown~859650002" } ], "placeholder": "", "underHelpText": "" } }, "relationshipChild": { "htmlLabel": "Relationship to {{data.chName}}", "label": "Relationship to", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Adult sibling", "value": "Adult sibling" }, { "label": "Extended family", "value": "Extended family" }, { "label": "Family friend", "value": "Family friend" }, { "label": "Other", "value": "Other" }, { "label": "Not related", "value": "Not related" } ], "placeholder": "", "underHelpText": "" } }, "relationshipToChild": { "htmlLabel": "Relationship to {{data.cName}}", "label": "Relationship to", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Birth parent", "value": "Birth parent" }, { "label": "Stepparent", "value": "Stepparent" }, { "label": "Carer", "value": "Carer" }, { "label": "Not related", "value": "Not related" } ], "placeholder": "", "underHelpText": "" } }, "relationshipToChildren": { "htmlLabel": "Relationship to the child/ren", "label": "Relationship to the child/ren", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "repeatedContent": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_1": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_2": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_3": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_4": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_5": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedContent_6": { "htmlLabel": "Repeated Content", "label": "Repeated Content", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeaderIndex": { "htmlLabel": "

{{Form.getItemProperty(\"data.parentContent\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_1": { "htmlLabel": "

{{Form.getItemProperty(\"data.childContent\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_2": { "htmlLabel": "

{{Form.getItemProperty(\"data.otherPersonContent\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_3": { "htmlLabel": "

{{Form.getItemProperty(\"data.childRepeat\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_4": { "htmlLabel": "

{{Form.getItemProperty(\"data.contentChild\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_5": { "htmlLabel": "

{{Form.getItemProperty(\"data.alternativeContact_1\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeaderIndex_6": { "htmlLabel": "

{{Form.getItemProperty(\"data.personResponsible\",\"itemLabel\")}} {{$index+1}}

", "label": "", "mandatoryMsg": "" }, "repeatedHeader_1": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader_2": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader_3": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader_4": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader_5": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatedHeader_6": { "htmlLabel": "Repeated Header", "label": "Repeated Header", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatingBlockCustom": { "htmlLabel": "", "label": "Repeating Block Custom", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatingBlockTemplate": { "htmlLabel": "", "label": "Repeating Block Custom", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatingBlockTemplate_1": { "htmlLabel": "", "label": "Repeating Block Custom", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatingBlockTemplate_2": { "htmlLabel": "", "label": "Repeating Block Custom", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "repeatingBlockTemplate_3": { "htmlLabel": "", "label": "Repeating Block Custom", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "reportDetails": { "htmlLabel": "When to report", "label": "When to report", "mandatoryMsg": "", "properties": { "additionalText": "Fields marked with * are required", "formName": "{{T[Form.view.id].label}}", "helpText": "", "menuText": "Report", "navAriaLabel": "Secondary wizard status", "sectionHeading": "{{T[item.id].label}}" } }, "reportedBefore": { "htmlLabel": "Have you reported before?", "label": "Have you reported before?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Yes", "value": "Yes~859650000" }, { "label": "No", "value": "No~859650001" } ], "underHelpText": "" } }, "reportersJudgement": { "htmlLabel": "Reporter’s judgement", "label": "Reporter’s judgement", "mandatoryMsg": "", "properties": { "additionalText": "Fields marked with * are required", "formName": "{{T[Form.view.id].label}}", "helpText": "", "menuText": "Judgement", "navAriaLabel": "Secondary wizard status", "sectionHeading": "{{T[item.id].label}}" } }, "reportingPersonName": { "htmlLabel": "Reporting Person Name", "label": "Reporting Person Name", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "resources": { "htmlLabel": "resources", "label": "resources", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "returnToForm": { "htmlLabel": "Click here to return to your form", "label": "Click here to return to your form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "returnToPortal_1": { "htmlLabel": "Return to portal", "label": "Return to portal", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "returnToPortal_2": { "htmlLabel": "Return to portal", "label": "Return to portal", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "ruleDone": { "htmlLabel": "Rule Done", "label": "Rule Done", "mandatoryMsg": "" }, "safetyIssues": { "htmlLabel": "What are all the good things in the child's life that makes things better for them? Who are the people who help?", "label": "What are all the good things in the child's life that makes things better for them? Who are the people who help?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "saveAndClose": { "htmlLabel": "Save and close", "label": "Save and close", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "saveComponent": { "htmlLabel": "Save Component", "label": "Save Success Component", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "saveConfirm": { "htmlLabel": "Confirm", "label": "Confirm", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "saveConfirm_1": { "htmlLabel": "Confirm", "label": "Confirm", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "saveYourForm": { "htmlLabel": "Save confirmation", "label": "Save confirmation", "mandatoryMsg": "" }, "save_challenge_question_section": { "htmlLabel": "Section", "label": "Section", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "save_challenge_reference_code": { "htmlLabel": "Reference code", "label": "Reference code", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "save_success_send_reminder": { "htmlLabel": "Send now", "label": "Send now", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "savechallenge": { "htmlLabel": "Save challenge", "label": "Save challenge", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "saveconfirm": { "htmlLabel": "Save confirm", "label": "Save confirm", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "savesuccess": { "htmlLabel": "savesuccess", "label": "savesuccess", "mandatoryMsg": "", "properties": { "alertMsg": "", "leavePageWarningMessage": "", "linkWarningMsg": "opens in a new window", "mandatoryMsgSuffix": "is required", "progressMsg": "Please wait..." } }, "scalingQuestion": { "htmlLabel": "

Where do you scale the situation at the moment on a scale of 0 - 10, where: *

\n\n

10 - means there have been some concerns for the child, but no more than any child in the community and there are people around making sure the child is okay.
\n0 - means I am so worried about the child, they have already been hurt or frightened and if something doesn’t change they could be seriously hurt or frightened again?

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email address e.g. name@example.com" } }, "serviceFee": { "htmlLabel": "Service Fee", "label": "Service Fee", "mandatoryMsg": "" }, "setFocus": { "htmlLabel": "Set Focus", "label": "Set Focus", "mandatoryMsg": "" }, "setFocus_2": { "htmlLabel": "Set Focus", "label": "Set Focus", "mandatoryMsg": "" }, "sex": { "htmlLabel": "Sex", "label": "Sex", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Female", "value": "Female~c5481167-a28b-e711-811d-c4346bdee581" }, { "label": "Indeterminate", "value": "Indeterminate~cb481167-a28b-e711-811d-c4346bdee581" }, { "label": "Intersex", "value": "Intersex~c9481167-a28b-e711-811d-c4346bdee581" }, { "label": "Male", "value": "Male~475e7aec-be8b-e711-811d-c4346bdee581" }, { "label": "Unknown", "value": "Unknown~c7481167-a28b-e711-811d-c4346bdee581" } ], "placeholder": "", "underHelpText": "" } }, "sexAdult": { "htmlLabel": "Sex", "label": "Sex", "mandatoryMsg": "", 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visit ACTMAPi.", "label": "If you require help with suburb/district, section or block details, visitACTMAPi.", "mandatoryMsg": "" }, "ssbHelp_2": { "htmlLabel": "If you require help with suburb/district, section or block details, visit ACTMAPi.", "label": "If you require help with suburb/district, section or block details, visitACTMAPi.", "mandatoryMsg": "" }, "startANewForm_1": { "htmlLabel": "Start a new form", "label": "Start a new form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "startANewForm_2": { "htmlLabel": "Start a new form", "label": "Start a new form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "state": { "htmlLabel": "State Data", "label": "State Data", "mandatoryMsg": "" }, "stateBlk": { "htmlLabel": "State", "label": "State", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "stateBlk_2": { "htmlLabel": "State", "label": "State", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "stateDD": { "htmlLabel": "State", "label": "State", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "ACT", "value": "ACT" }, { "label": "NSW", "value": "NSW" }, { "label": "NT", "value": "NT" }, { "label": "QLD", "value": "QLD" }, { "label": "SA", "value": "SA" }, { "label": "TAS", "value": "TAS" }, { "label": "VIC", "value": "VIC" }, { "label": "WA", "value": "WA" } ], "placeholder": "", "underHelpText": "" } }, "stateDD_2": { "htmlLabel": "State", "label": "State", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "ACT", "value": "ACT" }, { "label": "NSW", "value": "NSW" }, { "label": "NT", "value": "NT" }, { "label": "QLD", "value": "QLD" }, { "label": "SA", "value": "SA" }, { "label": "TAS", "value": "TAS" }, { "label": "VIC", "value": "VIC" }, { "label": "WA", "value": "WA" } ], "placeholder": "", "underHelpText": "" } }, 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Security Question
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Please review your security question and answer. This question must be correctly answered to re-open the form.

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Security question
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Your answer to this question must match the information you previously provided.

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For your records

", "label": "For your records", "mandatoryMsg": "" }, "textDisplay_12": { "htmlLabel": "

Send yourself a reminder email

\n

Enter your email address and we'll send you you instructions on how to return to your form.

", "label": "Send yourself a reminder email\nEnter your email address and we'll send you you instructions on how to return to your form.", "mandatoryMsg": "" }, "textDisplay_13": { "htmlLabel": "

Check your email

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We've sent instructions to your email address ({{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.send_reminder_email}}) on how to return to the application when you are ready.

\n\n

If you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.

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Check your email

\n\n

We've sent a copy of your submission to {{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.yourEmailAddress}}.

\n\n

If you didn't receive it or would like another copy, just select the option below.

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Reference code
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{{data.isCollab?\"\":\"When you saved your form you should have been provided a reference code.\"}}

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