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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

10-23-2017

Subchapter:

1

Forms

Issuance:

16.69

CP&P Form 16-69, Referral for Assistant Family Service Worker

 

Click here to view and print CP&P Form 16-69.

 

WHEN TO USE IT

 

This form is used to request transport of a client by an Assistant Family Service Worker. It is intended to ensure that the AFSW is aware of any and all circumstances which might create a risk to the safety of the client, the AFSW, or other persons.

The form is to be completed by the Worker at the time of referral for transportation. Contents of this form are confidential, and should not be shared with the client.

HOW TO USE IT

 

This form is now a template for on-line use.  Once it has been completed forward to appropriate supervisor for approval and determination of assignment.

 

 

DISTRIBUTION

 

Original   -   AFSW

 

Copy       -   Case Record