Download case staffing with legal - Florida`s Center for Child Welfare

CPI CASE STAFFING WITH LEGAL
Please make sure that you attach pertinent documentation to this staffing form. Documentation including
but not limited to photographs, drug/alcohol screens, service provider progress notes, school records, FSFN,
Court Orders, CPT Reports, Police Reports.
CSA #:
Date of Staffing:
Child(ren) Name(s) & D.O.B.:
Attorney:
CPI:
CHECK ITEMS APPLICABLE AND COMMENT AS NECESSARY
Serious physical injury to child related to DV
Caretakers have a history of significant DV
Prior reports: Number/Findings
Specify: Verified/Some Indicators/No Indicators
Priors with same or similar maltreatments
Caretaker has a significant documented drug or
alcohol problem.
Safety Plan:
Child seriously neglected resulting in harm
Criminal history that poses a threat of harm to child
Caretaker not able/willing to protect child from risk,
including possible A/P’s access
Paramour in the home
Services in home –
Specify: Referrals/Providers/Dates/Status
Is there an open DJJ court case?
FACTS/ALLEGATIONS:
LIST ALL PRIORS:
Services offered/Date of Referral/Follow Up:
STAFFING RECOMMENDATION:
Direct File
Shelter
No Judicial Action Needed -Reason:
Re-Staff
Date:
Outcome:
FOLLOW UP ITEMS:
ANY CHANGE IN CIRCUMSTANCE REGARDING THIS CASE MUST BE PRESENTED AND RESTAFFED WITH CLS AS
THAT MAY IMPACT THE RECOMMENDATION MADE.
CPI:
CLS:
Created 7/23/2012