CPS Record Review - North Carolina



CPS Record Review | |

|Family: LOG#: Date Received: |

|Response Time: SW: Reviewed By/Date: |

|Family Assessment Investigative Assessment |

|Children: |

| |

| |

|Initiated in time frames OR explained why not Initiation unclear |

|Parents/Caretakers: |

| |

| |

|Family Assessments: Parents contacted prior to initial f/f/explain why not |

|Seen same day as children/explained why not |

|Not seen same day, need reason |

|Non-primary perp or non-primary caretakers seen |

|Not seen; need explanation or contact N/A |

|Safety assessment Safety assessment missing/needs signed |

|Home visit completed, documented Visit or form needed |

|Collateral contacts/Referrals |

|Fam. Ass’ts: Parents present during interview w/collateral contacts |

|Fam. Ass’ts: Parents consented to contact of collaterals not in their presence |

|Fam. Ass’ts: Parents not present but informed of information provided by collaterals |

|Reporter Persons listed on intake: |

|Health School/daycare Significant relatives/witnesses |

|Agencies working with the family Income maintenance/child support worker |

|Work First worker CPCM/Foster Care worker Absent parent |

|Criminal record Drug test CAD report |

|CPS History Review DA/LE referral CMEP/CMHEP completed |

|Collateral contacts/referrals missing/needed: |

|If new allegations/report received, log # (s): |

|New report/allegations assessed thoroughly |

|N/A |

|Staffing for over 30 days 30 day staffing needed |

|Staffing for over 45 days 45 day staffing needed |

|Family informed of case over 45 days Family notification needed |

|Questions/Activities/Directives on any area above: |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|CFT held appropriately CFT needed |

|Risk Assessment/Strength and Needs completed |

|Risk Assessment/Strength and Needs needed or needs corrections |

|Completed with family? Y N |

|Services provided to family during assessment phase: |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Additional questions/activities/directives before case can be closed OR specific language for case decision: |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download