Try for free

Hawaii DHS 1516 Mandated Reporter Checklist (Child)

Hawaii's Department of Human Services uses DHS 1516 as the written report mandated reporters must send after an oral report of suspected child abuse or neglect. A clinician completes it from the records before calling the Child Abuse and Neglect Reporting Line, then faxes or mails it to DHS. Doing both meets HRS §350-1.1, which requires a written report as well as the oral one.

Who completes it

The mandated reporter completes the whole checklist, one per family, filling the required fields marked with double asterisks and leaving unknown items blank. It also records the intake social worker's name and any police report number from the oral report.

Submitting and payment

How to submit it
Call the Child Abuse and Neglect Reporting Line (Oahu or toll free) as soon as the checklist is complete, then fax or mail it to the DHS Intake Unit immediately after the oral report.
Who pays
Hawaii DHS lists no fee or payment for the report.

Good to know

  • Section A records actual harm as defined in HRS 587A-4: physical abuse, sexual abuse including sex and labor trafficking, psychological harm, neglect and intentional drugging.
  • Section B lists 15 safety factors, each supported only when four criteria are met: specific and observable, out of control, immediate or liable to happen, and severe consequences.
  • The checklist asks whether DHS may share your identity with county police or with its contracted VCM or FSS provider for follow-up.
  • Sections C to E cover risk factors, the family's prior services and treatment, and a narrative supporting your answers, with documents attached if helpful.

Get the official form

Download the current version from the source each time; forms change without notice.

Confidential Mandated Reporter Checklist for Suspected Child Abuse & Neglect

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Is the DHS 1516 checklist required in Hawaii?

Hawaii law (HRS §350-1.1) requires mandated reporters to make a written report as well as an oral report. DHS states that completing DHS 1516 and faxing or mailing it after the phone report fulfills that obligation. Filling it out first also prepares you for the questions on the call.

Should I call before or after filling out DHS 1516?

Complete the checklist first, using all available records, so the required information is ready. Then immediately call the Child Abuse and Neglect Reporting Line, note the intake social worker's name to document receipt of the referral, and fax or mail the checklist to DHS right after the oral report.

Is there a separate Hawaii checklist for human trafficking?

Yes. Hawaii DHS posts a separate Mandated Reporter Checklist for Human Trafficking alongside DHS 1516 and its Mandated Reporter Guide. DHS 1516 itself lists sex trafficking and labor trafficking among the forms of actual harm in Section A, using the current 05/2023 revision.