Referral & Initial Intake (Form 5A)
Version 3.0 · For Department of Communities, court / legal and private (family) referrals
Please complete every section that applies. Write “N/A” where a question does not apply and “Unknown” where information is not yet available.
We will acknowledge your referral within two (2) business days and advise our intake decision in writing within five (5) business days of receiving a complete referral.
If anyone is in immediate danger, call 000.
- Submitting this form does not guarantee acceptance. Safe Steps makes its own decision following triage and risk assessment.
- Safe Steps may refuse, suspend, or terminate services on safety grounds at any time.
- Safe Steps is independent and not bound to accept court orders where doing so would be unsafe.
- Information provided is handled confidentially in accordance with the Privacy Act 1988 (Cth) and, for Department referrals, the Children and Community Services Act 2004 (WA).
- This form captures the minimum information required to commence triage. Further risk, background, and case detail is gathered through the Safe Steps intake stages (2–6).
Safe Steps Children's Contact Services Pty Ltd · ABN 86 695 663 015 · +61 475 201 348 · info@safestepsccs.com.au