This document is a supervisory case review guide for a Child Protective Services intake case. It contains questions to evaluate if the intake caseworker completed all required screening activities, documentation, and response timelines. If issues are found, corrections are requested from the caseworker. The supervisor provides an overall evaluation and any additional comments.

1. Intake
Child Protective Services
Supervisory Case Review Guide
County: Review Date (mm/yy): Name of Supervisor:
Case number: Name of Client:
Name of Caseworker (assigned to case ad time of supervisory review):
Review Guide Questions Yes No N/A
Intake
1. Were all screening activities completed, documented and dated on the Intake
Worksheet? (form #453)
2. Does the form #453 reflect that the intake report was sent to the
District Attorney or Law Enforcement?
3. Were all screening activities completed, documented and dated on the Intake
Worksheet? (form #453)
4. Were all screening activities completed, documented and dated on the Intake
Worksheet? (form #453)
5. Did the intake case manager thoroughly complete the Intake Worksheet?
6. Was the appropriate response time assigned and verified by the
supervisor/designee? Response time: 24 Hours 5 Days: SO:
Date of Report: Date Assigned:
Case Review Results
Supervisory Case Review Discussion With Caseworker
Case Corrections Needed? No Yes Date Due:
Case Corrections Completed: Date:
Supervisory Case Review Comments:
CPS_187 CPS Intake Supervisory Case Review Guide (Rev 09/06) Page 1 of 1