Report Elder Abuse and Neglect

If you believe that an adult age 60 or older has suffered abuse, neglect or exploitation, you may file a report with Erie County Department of Job & Family Services at 419-626-KIDS or 419-627-4490.

Information on alleged victim:

Concern of:
Physical abuseNeglect by othersSelf-neglectExploitation

Full Name:

Date of Birth:

Approximate Age:

Address:

Phone:

County of residence:

Gender:

What is the concern—please be specific:

If allegation is for physical abuse, please provide additional details on injuries received and location on the person:

Are you aware of any substance abuse concerns for the adult you are reporting on:

Who is the alleged perpetrator (who do you think is responsible for causing your concern for the adult:
Name:

Address:

Is the alleged perpetrator:
Related to the victimA caretaker for the victimUnknown to the victimUnknown

Does the victim have any of the following (check all that apply)
A GuardianPOA

If so, who holds the POA?:

Who else lives in the home: Name and relationship:

Are there any community services providers in the home:

Information about who's reporting the concern:

(Please understand your information is strictly confidential. By completing the information about yourself, we would be able to contact you directly with any clarifying questions we have in order to determine the appropriate course of action)

Name:

Contact Address:

Have you reported on this individual before?
YesNo

Erie County Children’s Services Mission

To serve as a first responder to reported allegations of child abuse &
neglect, to investigate such reports in a timely manner and to provide
appropriate protective services to children who are found to be abused
and neglected in accordance with legal mandates.

Erie County Children’s Services
221 W Parish St,
Sandusky, OH 44870
419-626-6781