Social Services Case Management Checklist Template
Ensure thorough case handling and improve client outcomes with our Social Services Case Management Checklist Template. Streamline workflows, stay compliant, and deliver exceptional support-download now for a more efficient and effective case management process.
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Initial Assessment & Intake
Tasks related to the initial contact, information gathering, and needs assessment of the client.
Date of Initial Contact
Time of Initial Contact
Client Full Name
Client Contact Number
Reason for Contact (Client/Referral Source)
Referral Source
Immediate Needs Identified
Client Location (if applicable)
Client Background & History
Documentation of relevant client history, including family, education, employment, and prior services.
Family History & Dynamics
Educational Background & History
Employment History
Number of Dependents
Date of Birth
Prior Mental Health Diagnoses (if any)
Significant Life Events
Needs Identification & Prioritization
Detailed list of identified needs and prioritization for service delivery.
Describe Client's Immediate Needs
Estimated Income Level (Annual)
Housing Stability?
Identified Needs (Select all that apply)
Severity Rating (1-5, 1=Low, 5=High)
Date Need First Identified
Service Planning & Goal Setting
Development of a case plan with specific, measurable, achievable, relevant, and time-bound (SMART) goals.
Problem Statement
Desired Outcome(s)
Goal Priority (High/Medium/Low)
Target Completion Date (days from start)
Planned Review Date
Strategies to Achieve Goal
Contingency Planning (Potential Barriers & Solutions)
Resource Coordination & Referrals
Tasks involving connecting clients with appropriate resources and services (housing, food assistance, legal aid, etc.).
Referral Source
Housing Assistance Needed?
Food Assistance Needed?
Legal Aid Referral Needed?
Referral Notes (Specific instructions or details for the referral agency)
Referral Date
Contact Person at Referral Agency
Phone Number of Referral Agency
Service Delivery & Monitoring
Ongoing tasks related to providing services and tracking client progress towards goals.
Scheduled Service Delivery Date
Service Delivery Time
Description of Services Provided
Quantity of Service Units Delivered
Service Provider
Challenges Encountered During Service Delivery
Notes on Client Response to Services
Documentation & Record Keeping
Ensuring accurate and complete documentation of all case activities and client interactions.
Date of Initial Contact
Summary of Initial Assessment Notes
Case File Status
Number of Client Contacts Recorded
Supporting Documents
Notes on Document Review
Case Manager Signature
Progress Review & Evaluation
Regularly reviewing progress, adjusting the case plan as needed, and evaluating outcomes.
Date of Progress Review
Summary of Progress Since Last Review
Progress Towards Goal 1 (Scale of 1-10)
Progress Towards Goal 2 (Scale of 1-10)
Overall Assessment of Progress
Explanation of Assessment (if not 'On Track')
Case Plan Adjustments Needed?
Details of Case Plan Adjustments (if needed)
Next Review Date
Case Closure & Discharge Planning
Tasks related to formally closing the case and ensuring a smooth transition for the client.
Planned Discharge Date
Summary of Services Provided
Discharge Plan Details (Housing, Transportation, Follow-up)
Discharge Disposition
Referrals Provided at Discharge
Contact Information for Follow-up (if applicable)
Case Manager Signature
Client Signature (Acknowledgement of Discharge)
Compliance & Reporting
Ensuring adherence to relevant regulations, policies, and reporting requirements.
Last Compliance Review Date
Applicable Regulations (Check all that apply)
Summary of Compliance Findings (if any)
Number of Reported Incidents (related to compliance)
Supporting Documentation (e.g., Audit Reports)
Compliance Status
Name of Compliance Officer
Next Compliance Review Date
Case Management Screen Recording
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