CHILD WELFARE CASE MANAGEMENT CHECKLIST TEMPLATE

Created by ChecklistGuro (https://checklistguro.com)


--- INTAKE & REFERRAL ---
[ ] Date of Referral
[ ] Referring Agency/Source Details
[ ] Reason for Referral (Neglect, Abuse (Physical), Abuse (Emotional), Abuse (Sexual), Abandonment, Other)
[ ] Child's Full Name
[ ] Parent/Guardian Name(s)
[ ] Child's Current Address
[ ] Child's Age

--- FAMILY ASSESSMENT ---
[ ] Presenting Concerns/Reasons for Referral
[ ] Family Structure & Composition (Nuclear Family, Single Parent Family, Blended Family, Extended Family, Foster Family)
[ ] Number of Children in Household
[ ] Date of Birth (Parent 1)
[ ] Parent 1 Occupation
[ ] Parent 1 Education Level (High School, Some College, Associate’s Degree, Bachelor’s Degree, Graduate Degree)
[ ] Summary of Strengths Observed

--- SAFETY PLANNING ---
[ ] Immediate Safety Threats Identified
[ ] Safe Place(s) Designated for Child
[ ] Safety Plan Review with Family? (Yes, No)
[ ] Family’s Understanding of Safety Plan
[ ] Date Safety Plan Implemented
[ ] Safety Measures Implemented (Check all that apply) (Restricting Contact, Relocation, Supervised Visits, Emergency Shelter, Other)
[ ] Contact Information for Emergency Contacts

--- SERVICE COORDINATION ---
[ ] Primary Service Need (Mental Health Counseling, Substance Abuse Treatment, Housing Assistance, Medical Care, Educational Support, Legal Aid)
[ ] Service Provider Notes
[ ] Service Units Provided
[ ] Service Start Date
[ ] Service End Date (if applicable)
[ ] Service Provider (Agency A, Agency B, Agency C)
[ ] Supporting Documentation (e.g., referral, invoice)

--- LEGAL PROCEEDINGS ---
[ ] Initial Filing Date
[ ] Case Number
[ ] Court Type (Family Court, Juvenile Court, Probate Court)
[ ] Hearing Date
[ ] Hearing Time
[ ] Summary of Court Proceedings
[ ] Court Documents Upload
[ ] Order Number

--- VISITATION ---
[ ] Scheduled Visitation Date
[ ] Scheduled Visitation Start Time
[ ] Visitation Location
[ ] Visitation Observation Notes
[ ] Visitation Outcome (Successful, Modified, Cancelled, Unsuccessful)
[ ] Caseworker Signature
[ ] Number of Attendees (excluding child)

--- PROGRESS MONITORING ---
[ ] Last Progress Review Date
[ ] Progress Score (1-10)
[ ] Summary of Progress and Challenges
[ ] Service Plan Modifications Needed? (Yes, No)
[ ] Next Review Date
[ ] Specific Goals Met/Not Met
[ ] Areas Requiring Further Support (Housing, Financial Assistance, Mental Health Services, Substance Abuse Treatment, Parenting Skills Training, Educational Support)

--- CASE CLOSURE ---
[ ] Case Closure Date
[ ] Summary of Case Outcomes & Progress
[ ] Reason for Case Closure (Reunification, Permanent Placement, Aging Out, Other)
[ ] Summary of Services Provided
[ ] Total Services Provided
[ ] Final Case Report
[ ] Case Worker Signature
[ ] Follow-up Required? (Yes, No)

--- DOCUMENTATION & RECORD KEEPING ---
[ ] Date of Initial Record Creation
[ ] Summary of Initial Assessment Notes
[ ] Upload of Initial Assessment Documents (e.g., referral, reports)
[ ] Case File Number
[ ] Record of Communication Log (dates, people, topics)
[ ] Document Status (Draft, Reviewed, Final)

--- REPORTING & COMPLIANCE ---
[ ] Last Report Submission Date
[ ] Report Type (Monthly Progress Report, Annual Report, Incident Report, Court Report)
[ ] Case ID
[ ] Summary of Findings
[ ] Compliance Status (Compliant, Non-Compliant, Partially Compliant)
[ ] Supporting Documentation

--- END OF TEMPLATE ---
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