Child Protective Services Follow-Up Evaluation
Case Number
Child Name
Date of Birth
Date of Evaluation
CPS Worker Name
Supervisor Name
Current Status of Child
Current Placement
Wellbeing Assessment
Family Environment
Household Members
Family Support & Interaction
Services Provided
List of Services Provided
Services Outcome
Risk Assessment
Risk Factors Identified
Safety Concerns
Recommendations
Recommendations and Next Steps
Next Follow-Up Date