Form DCF-2180 "Safety Plan" - Connecticut

What Is Form DCF-2180?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-2180 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-2180 "Safety Plan" - Connecticut

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Connecticut Department of Children and Families
SAFETY PLAN
DCF-2180
3/2017 (Rev.)
Page 1 of 1
TO THE FAMILY: The purpose of this Safety Plan is to outline the responsibilities each person has in creating and maintaining
conditions that will ensure that your child(ren) are safe in your home. Your participation and input in the development of this Safety
Plan, while voluntary, is important. This Safety Plan will be in effect until the review date noted at the top of the plan. The plan may
be changed if your family’s situation or circumstances change. If an unsafe situation develops for your children, it may result in DCF
taking stronger action to ensure their safety.
TO THE SOCIAL WORKER: If any safety factors have been identified, please describe the Safety Plan, which will be implemented
to specifically address each identified safety factor.
Select one review date for the most acute activity, then update as needed. Review Date: __________________________
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Parent/Guardian:
Date:
Parent/Guardian:
Date:
Social Worker:
Date:
Connecticut Department of Children and Families
SAFETY PLAN
DCF-2180
3/2017 (Rev.)
Page 1 of 1
TO THE FAMILY: The purpose of this Safety Plan is to outline the responsibilities each person has in creating and maintaining
conditions that will ensure that your child(ren) are safe in your home. Your participation and input in the development of this Safety
Plan, while voluntary, is important. This Safety Plan will be in effect until the review date noted at the top of the plan. The plan may
be changed if your family’s situation or circumstances change. If an unsafe situation develops for your children, it may result in DCF
taking stronger action to ensure their safety.
TO THE SOCIAL WORKER: If any safety factors have been identified, please describe the Safety Plan, which will be implemented
to specifically address each identified safety factor.
Select one review date for the most acute activity, then update as needed. Review Date: __________________________
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Safety factor:
Parent/guardian will do the following:
DCF will do the following:
Parent/Guardian:
Date:
Parent/Guardian:
Date:
Social Worker:
Date: