INSTRUCTIONS: ARIZONA CHILD ABUSE OR NEGLECT REPORT (Form PS-020-A)

To report child abuse in Arizona, a form PS-020-A can be filed with the Division of Children, Youth and Families. This is a sub-section of the Arizona Department of Economic Security. This report can be filed by any person who believes a minor has been the victim of physical abuse, injury, reportable offenses or neglect that appear to have resulted deliberately rather than accidentally. No criminal prosecution will occur if the report is inaccurate as long as it was submitted in good faith. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Child Abuse Or Neglect Report PS-020-A Step 1: In the first blank box, enter the child's last name, first name and middle initial.

Arizona Child Abuse Or Neglect Report PS-020-A Step 2: In the second blank box, enter the date.

Arizona Child Abuse Or Neglect Report PS-020-A Step 3: Check the first box if you observed any burns.

Arizona Child Abuse Or Neglect Report PS-020-A Step 4: Check the second box if you observed any bruises.

Arizona Child Abuse Or Neglect Report PS-020-A Step 5: Check the third box if you observed any lacerations.

Arizona Child Abuse Or Neglect Report PS-020-A Step 6: Check the fourth box if you observed any fractures.

Arizona Child Abuse Or Neglect Report PS-020-A Step 7: Check the fifth box if you noticed other forms of injury.

Arizona Child Abuse Or Neglect Report PS-020-A Step 8: The next five boxes concern the color of the injuries. Check the sixth box if the color was bright red.

Arizona Child Abuse Or Neglect Report PS-020-A Step 9: Check the seventh box if the color was purple.

Arizona Child Abuse Or Neglect Report PS-020-A Step 10: Check the eighth box if the color was blue.

Arizona Child Abuse Or Neglect Report PS-020-A Step 11: Check the ninth box if the color was green.

Arizona Child Abuse Or Neglect Report PS-020-A Step 12: Check the tenth box if the color was yellow.

Arizona Child Abuse Or Neglect Report PS-020-A Step 13: Each injury and color is matched to a letter and number, respectively. On the child diagrams, write each letter and number where appropriate.

Arizona Child Abuse Or Neglect Report PS-020-A Step 14: Print and sign your name. Date the form.