WPC ?npՠ~)5$tJ5H du1zdDOtת˭iT}[! FݣjH6ԍt׺MӟeW4dOV s|U,S~9A3E""]Ԁ-2 fZh!y}dw7HkXӶ KvݦPU1u|ظ%죚$ɣwr9ew}:Zw47ˣj$"Small Circle"0   d !  _HXXXX   8i\\dd8&J%XX COMPLETINGTHESAFETYASSESSMENT,CFS2030B#XX%&J#XX  i #XXL#XXTheSafetyAssessmentshouldbecompletedonanychildlistedontheCFS1000.Thesafetyassessmentistoassess v thesafetyofthechildtoremainathomeortoreturnhome(suchasfrompoliceprotectivecustody).Completethis :^ formonlyforchildabuse/neglectcases.#G# " 3  3g"0    CASENAME: 󀀀Usethesamecasenameasonpage1,SectionII,#1offormCFS1000.3g݌ (#(# Ќ  3  3M"0    CASENUMBER: 󀀀Usethesamecasenumberasonpage1offormCFS1001.3Mh݌ 4(#(# Ќ  3  3'"0    EVENTNUMBER: 󀀀Usethesameeventnumberasonpage1offormCFS1001.3'B݌  (#(# Ќ  3  3"0    SOCIALWORKER: 󀀀EnterthenameoftheassignedworkerfromformCFS1002,page2,SectionIII. 3݌$H (#(# Ќ  3  3"0    DATEOFASSIGNMENT: 󀀀EnterthedateofcaseacceptancefromformCFS1002,page1.3݌ (#(# Ќ  #2# SectionI:IMMINENTDANGERANDOTHERSAFETYFACTORS 8\    0  Identifytheimminentdangerthatexistsforany##child(_ren_)inthehomeorreturninghomepriortoany @z!    intervention(e.g.service,workeraction,referral,useoffamilyresources).Check"YES"foralltypeslisted.   ` Suchjudgementshouldtakeintoaccounttheageordiminishedcapacityforselfprotectiondueto @"  @"  Dh diminishedmentalorphysicalcapacityorrepeatedvictimization.,(#(#   ## 0  Eachdangertype yesshallbequalified.Dangertypesrelatedtotheallegationswhicharemetwitha   noshallbequalified.# ( ##XX#XXTx(#(# 0  If_SRS_Ԁisunabletolocateafamily,thisisindicatedasanOTHERsafetyfactorreasononnumber16.Any  additionalinformationregardingthesafetyassessmentshouldbedocumentedinothersafetyfactors.(#(#  SectionII:IMMEDIATEMEDICALCONCERNS(SCREEN) (L     ` 0  WASMEDICALEXAMINATIONORTREATMENTRELATEDTOABUSEORNEGLECT  NEEDED? r (#(# 0  Indicateifthechild(_ren_)wasfoundtobeinneedofurgentorimmediatemedicalattentionduetothe 6Z! alleged ` abuseorneglect.Medicalcare,asusedinthissection,shouldrelatetomedicalneedsresulting " fromsuspectedchildabuseorneglectandshouldnotbeconstruedtoincludemedicalcareortreatment  # whichisnonurgentorelective.Thisdoesnotincluderoutinemedicalconcerns.!$(#(#   Ifansweris Yes,describeactionstakentoensuremedicalcarewasprovided. Reasonableactionmeans  #.&   takingstepswhichcanbeexpectedtorelievepainandsuffering,preventfurtherharm,preventpermanent #'   injuryand/orpreserveevidence. $(   # # SectionIII:SAFETY/HARMDESCRIPTIONANDPROTECTIVEACTIONRESPONSE. &> *  #w#   0  Eachdangertype"yes"shallbequalified.Dangertypesrelatedtotheallegationswhicharemetwitha"no" '!, maybequalified.d("-(#(# 0  Pleasedescribethefollowing,specifying # #Ԁ whichchild Ԁisaffectedbythatdangertype.)$/(#(# 0  1.Theimmediatedangerandsafetyfactor(s)indicatedincludingthefrequencyofincident,contextof *$0 situation,andconditionsorcircumstancessurroundingtheabuseorneglect.Thenarrativemayinclude v+%1 othersafetyfactorsiftheyapply. :,^&2(#(# 9% 'DL!X9   ' 2.# n#Reasonableeffortstopreventoutofhomeplacementand/or Ԁprotectiveactiontakentoprotectthechild ,"'3    ' consideringthefollowingactions 0K.'4 <DL!'XKandresourcesavailabletothefamily: -'4 Ѐ   '  4 familyresources,neighbors,orotherindividualsinthecommunity 0  Ѐ   '  4 communityagenciesorservices  Ѐ   '  4 allegedperpetratorleavesthehomevoluntarilyorinresponsetolegalaction d Ѐ   '  4 nonmaltreatingcaregiverandchildmovetoasafeenvironment# # (L Ѐ   '  4 workeractiontakenoragencyservices/resourcesprovided  0  0'(#(#04'(#'(#  Ifsafetyplaniscompleted,youmayreferencethesafetyplanforsafetyresponsetaken.Ifno t  protectiveaction(reasonableefforts)canbedevelopedtoprotectthechild,explain. 8 \4(#4(# 0  0'(#(#04'(#'(# Note:IFCHILDISINCUSTODYANDOUTOFHOMEPLACEMENT,WHATREASONABLE    EFFORTSWEREMADEANDWHATSERVICESWERECONSIDEREDTOPREVENT    PLACEMENT . Summarizetheeffortsthatweremadetopreventthechildfromcominginto_SRS_ Hl  custodyand/ortoavoidthenecessityofanoutofhomeplacement.Thesummaryshouldincludeany 2  servicesthatwereconsideredintheseefforts.## D  4(#4(#  SectionIV:SAFETYDECISION  X|     ' 0  Thesocialworkeridentifiesthesafetydecisionbycheckingtheappropriateresponse.Checkonlyoneresponse.   Thisdecisionshouldbebasedontheassessmentofallsafetyfactorsandanyotherinformationknownaboutthis   case.f(#(#  0  Safe: Therearenochildren/youthinimminentdangerofseriousharmandnoprotectiveactionisrequiredat  thistime."Safe"shouldbecheckedonlyifnosafetyfactorswereidentifiedinSectionI.(#(#  0  ConditionallySafe: Controllingsafetyinterventionshavebeentakensincetheintakewasreceived,andthose @"  :^ interventionshaveresolvedtheunsafesituationforthepresenttime. $(#(#  #e##XXZ #XXXXXXd0  ddChecktheboxindicatingifthefamilyoranotheragencyhastakenprotectiveactionandspecifythetasksand  personresponsibleorif_SRS_Ԁisrecommendingprotectiveactionandcompletingasafetyplan.d Jn(#(#  #XX"#XX#"#  _ '  4    <      D      L    ! _0  Unsafe: Withoutcontrollinginterventions(removalfromthehome),oneormorechildren/youthwilllikelybein  imminentdangerofseriousharm.(#(#  0  0'(#(#04'(#'(# CUSTODYSCREEN:@!4(#4(# 0  0'(#(#04'(#'(#0 4(#4(#Thisscreenistobecompletedforanychildforwhomarequestforcustodyisbeing " considered.Ifchildisalreadyincustody,leavethissectionblank. # (# (# #w$#0   '  4 ISTHECHILDABANDONED?,"P%(#(#    '  4  Indicate Yesor No. "&    '  4  If No,respondtothefollowingthreequestions: #' 0  0'(#(# 4   (1)Isthechild(_ren_)inimminentdanger?x$('(#'(# 0  0'(#(# 4   (2)Isthenonabusingparentunabletoprotectthechild(_ren_)?and<%`)'(#'(# 0  0'(#(# 4   (3)Doestheperpetratorhaveaccesstothechild?&$ *'(#'(#    0  0'(#(#04'(#'(#0 4(#4(# Itisagencypolicythat_SRS_Ԁwillnotrequestlawenforcementprotectivecustodyoranexparte '!, orderofcustodyunlessallthreeconditionsaremet,orthechildisabandoned.J(n"- (# (# 0  0'(#(#04'(#'(#DID_SRS_ԀREQUESTLAWENFORCEMENTPROTECTIVECUSTODYORANEXPARTE )#/ ORDEROFCUSTODY?*$04(#4(# 0  0'(#(#04'(#'(#0 4(#4(#Indicateyesornoif_SRS_Ԁrequestedlawenforcementprotectivecustodyoranexparteorderof Z+~%1 custody.Enterthedateandtime_SRS_Ԁrequestedlawenforcementprotectivecustodyoranex ,B&2 parteorderofcustody.,'3 (# (#  -'4 _* [4ddd Xdd Xdd X(#(#,dd +   PPracticeNote:Completionofthequestionsnecessarytorequestanexpartecourtorder/police @d protectivecustodyorderisREQUIREDifthechildhasbeendeterminedunsafeorthechildis ( currentlyinprotectivecustody.However,itwouldbebestpracticetocompletethesequestionson  allcases.  #XX5$#