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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

3-9-2009

Subchapter:

1

Forms

Issuance:

22.5

CP&P Form 22-5, New Jersey Child Safety Assessment in Resource Family Homes COVER SHEET

 

Click here to view CP&P Form 22-5, New Jersey Child Safety Assessment in Resource Family Homes COVER SHEET

 

WHEN TO USE IT

 

The form provides background information needed by a Worker when conducting a child safety assessment in a resource family home or other family-based substitute care setting.

 

HOW TO USE IT

 

Complete this form in the NJ Spirit application, by accessing it through Create >Resource Work > Maintenance Drop-down.

 

Only complete this template outside of the NJ Spirit application as part of a contingency plan when the application is unavailable.  However, in doing so, you are still required to create the form in NJ Spirit when the application becomes available.

 

TIPS FOR COMPLETING THE FORM

 

     •     If more than one resource parent, enter the name of the second provider.

 

     •     Enter "Notable Concerns" regarding each child residing in the home, such as special needs, disabilities, substance use, fire setting tendencies.

 

     •     Enter the names of the resource providers' own children, adopted children or other children residing in the home who were not placed by CP&P.

 

     •     Enter information from OOL regarding the status of the license.

 

     •     Information prefills to document one incident investigated by IAIU.  Enter information about additional incidents in the addendum.

 

     •     In Part 2, item C, document contact with the Local Office Child Health Unit Nurse and the status of the child's health care.

 

     •     For a contracted foster home, enter information in part 3.

 

     •     If a waiver was granted to use the home, enter details.

 

The Worker and Supervisor sign and date the form.

 

DISTRIBUTION

 

Copy                           -           Child's case record

 

Copy                           -           Office of Licensing

 

Copy                           -           Contracted Agency,

                                               for a Contracted Agency home

 

Copy                           -           IAIU, when appropriate

 

Copy                           -           Interstate Services Unit,

                                              when the home is located out of state

 

Electronic Copy        -           NJ SPIRIT Electronic Case Record