Skip to Main Content
Do Not Show Again
How Do I...
Select a Category
Board of County Commissioners
Board of Elections
Canine Care and Control
Child Support Enforcement Agency
Clerk of Courts
Common Pleas Court
Domestic Relations Court
Emergency Management Agency
Emergency Medical Services / 911
Integrated Justice Systems
Job and Family Services
Juvenile Treatment Court
Local Emergency Planning Committee
Lucas County Sheriff
Office of Management and Budget
Ohio 6th District Court of Appeals
Planning and Development
Soil and Water Conservation
Water Resource Recovery Facility
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
PREA Sexual Abuse, Sexual Assault, or Sexual Harassment Reporting Form
This form has been modified since it was saved. Please review all fields before submitting.
Youth Last Name
Youth First Name
Youth Middle Initial
Youth Location at Time of Incident:
-- Select One --
Juvenile Detention Center
Youth Treatment Center
Residential Treatment Placement
Ohio Department of Youth Services
Juvenile Court Probation
Youth Advocate Program
Youth Assessment Center
Date and Time of Suspected Incident(s):
Date and Time of Suspected Incident(s): Start Date
Date and Time of Suspected Incident(s): Start Time
Date and Time of Suspected Incident(s): End Date
Date and Time of Suspected Incident(s): End Time
Alleged Staff Member(s) Involved:
List name(s) of staff member(s) involved.
Alleged Youth Involved:
List name(s) of youth other than victim involved.
Please Describe Suspected Abuse:
Anonymous reports will always be investigated, however, if you leave contact information, it provides us with the best opportunity to follow-up. Thank you.
Your Last Name:
Your First Name:
Your Middle Initial:
Your Phone Number:
Your Email Address:
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Slideshow Left Arrow
Slideshow Right Arrow