Mandatory Employer report of:
Mandatory RSW report of:
Correspondence from the College will be sent to you by regular, electronic and/or, in some cases, registered mail at the address you have provided.
Employment Setting Select all that apply:
if different from person filing the report
Employment Status
If filing report about more than one Social Worker, please submit a separate form for each individual.
Describe the conduct or actions of the RSW that prompted this report. Please ensure you provide sufficient details to support a thorough investigation.
Please provide the names and contact information of individuals with information regarding this incident such as colleagues, superiors and/or clients. Do not disclose client names unless you have their consent to do so.
Did the employer complete an internal investigation of this incident?
Please include copies of any internal investigation/audit relevant to this issue.
Supporting Documents Attached. Accepted Types: .pdf .txt .doc .docx .jpeg .png
I have read the Mandatory Reporting Guide, provided all relevant information required in the Mandatory Reporting Form and have included all relevant supporting documents in my submission.
I understand that in addition to the College Committees identified in the Mandatory Reporting Guide, the MCSW Board of Directors, MCSW staff, and practicum students may have access to information regarding this report while performing the duties of their positions. All MCSW representatives are required to maintain confidentiality of information in accordance with Section 71 of the SWPA.
I understand that as part of the reporting process MCSW may obtain information, including records and clinical notes, contained in the records of the RSW who is the subject of the report as part of the investigation and any or all of the information contained in this report or obtained as part of the investigation may be shared with the RSW who is subject of the report. Including the name of the person who reported.
The information on this form is collected under the authority of The Social Work Profession Act. The information provided will be used to process my report
I understand that if this report is referred to the Inquiry Committee, personal information and other information collected during the investigation must be disclosed to the member and may be considered during a hearing of the Inquiry Committee, which is a public forum.