Child Welfare Case Closure Report
General Information
Case ID
Date of Closure
Case Worker Name
Supervisor Name
Child Information
Child Name
Date of Birth
Gender
Family/Guardian Information
Parent/Guardian Name(s)
Relationship to Child
Contact Information
Case Summary
Reason for Referral
Summary of Services Provided
Family/Child Progress
Reason for Case Closure
Outcome and Recommendations
Child's Current Status
Risks or Concerns Remaining
Follow-up Recommendations
Signatures
Case Worker Signature
Date
Supervisor Signature
Date