Child Welfare Case Management Checklist Template
Ensure every child receives the best possible care. Our Child Welfare Case Management Checklist Template provides a structured approach to tracking progress, documenting actions, and maintaining compliance. Simplify complex casework and improve outcomes with this essential resource.
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Intake & Referral
Initial assessment and referral source documentation.
Date of Referral
Referring Agency/Source Details
Reason for Referral
Child's Full Name
Parent/Guardian Name(s)
Child's Current Address
Child's Age
Family Assessment
Comprehensive evaluation of family dynamics, needs, and strengths.
Presenting Concerns/Reasons for Referral
Family Structure & Composition
Number of Children in Household
Date of Birth (Parent 1)
Parent 1 Occupation
Parent 1 Education Level
Summary of Strengths Observed
Safety Planning
Development and implementation of immediate safety measures for the child.
Immediate Safety Threats Identified
Safe Place(s) Designated for Child
Safety Plan Review with Family?
Family’s Understanding of Safety Plan
Date Safety Plan Implemented
Safety Measures Implemented (Check all that apply)
Contact Information for Emergency Contacts
Service Coordination
Arranging and monitoring access to necessary services (e.g., therapy, counseling, housing).
Primary Service Need
Service Provider Notes
Service Units Provided
Service Start Date
Service End Date (if applicable)
Service Provider
Supporting Documentation (e.g., referral, invoice)
Legal Proceedings
Tracking court hearings, filings, and legal mandates.
Initial Filing Date
Case Number
Court Type
Hearing Date
Hearing Time
Summary of Court Proceedings
Court Documents Upload
Order Number
Visitation
Monitoring and documentation of parent-child visitation schedules.
Scheduled Visitation Date
Scheduled Visitation Start Time
Visitation Location
Visitation Observation Notes
Visitation Outcome
Caseworker Signature
Number of Attendees (excluding child)
Progress Monitoring
Regular review of case progress and adjustments to the plan as needed.
Last Progress Review Date
Progress Score (1-10)
Summary of Progress and Challenges
Service Plan Modifications Needed?
Next Review Date
Specific Goals Met/Not Met
Areas Requiring Further Support
Case Closure
Finalization of the case, including documentation and follow-up procedures.
Case Closure Date
Summary of Case Outcomes & Progress
Reason for Case Closure
Summary of Services Provided
Total Services Provided
Final Case Report
Case Worker Signature
Follow-up Required?
Documentation & Record Keeping
Ensuring all interactions, assessments, and plans are accurately documented.
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
Reporting & Compliance
Adherence to reporting requirements and agency policies.
Last Report Submission Date
Report Type
Case ID
Summary of Findings
Compliance Status
Supporting Documentation
Case Management Screen Recording
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