Incident Report Form

J4K Incident Report Form

The Florida Legislature and the U.S. Department of Justice have initiated probes into abuse, neglect and discrimination at Florida's Department of Juvenile Justice facilities. If you wish to report an incident, complete this form and click Submit Form to send your report to justice4kids. The person submitting this form is the Reporter. All questions must be answered.

If you are not prepared to enter specific details, then do not use this form. See note at the bottom of this page.

Reporter's name
Reporter's Phone # (123.456.7890)
Reporter's E-Mail Address (optional)
Reporter's relationship to youth:

Youth's Name
Youth's Date of Birth (mm/dd/yy)

JPO or Staff Name
DJJ facility where incident occurred
Date of Incident (mm/dd/yy)

Describe what happened.

Note: To remain anonymous and still report specific complaints or concerns that relate to law violations or policy violations, call (use pay phone) the DCF Abuse Hotline: 800-96ABUSE, DJJ CCC (Central Communications Center): 800-355-2280, or Local law enforcement.

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