SOM - State of Michigan



Case Name: 5 Day Due Date:Child (ren) Names and DOB:10 Day Due Date:Items below need to be completed no later than 5 days of removal or CPS will be responsible for completing the FC ISP within MISACWIS. ___Contact HLO within 24 hours of placement and where new placement is___DHHS 588 Initial Safety Screen completed and signed by CPS supervisor, caregivers, and DHHS County Director (Copy)___Copy of E-mail providing written notice to ES worker of removal___Copy of Consent to Treatment Card. DHHS 3762___DHHS 987 Relative Documentation (Copy)___DHHS 990 Relative Notification (Copy)___DHHS 988 Relative Search Information (Copy)___Court orders (Removal petition and Preliminary Order, FOC Orders, Affidavit of Parentage, Past or Current Guardianship Orders, etc.)___Picture of the Enrollment Letters for school for each child. (Copy) –Please be advised school age children need to be enrolled in school within 5 days.___Safe Sleep Brochure provided (if applicable)___CPS case transfer meeting with CPS supervisor, FC supervisor and FC worker___CPS Arranged and supervised First VisitDate:Time:Person transporting child/children:______________________________________________________________________CPS Supervisor SignatureDate______________________________________________________________________CPS Worker SignatureDate______________________________________________________________________FC Supervisor SignatureDate______________________________________________________________________FC Worker SignatureDate ................
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