Form CFS2025 "Home Safety Checklist for Intact and Permanency Workers" - Illinois

What Is Form CFS2025?

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

Form Details:

  • Released on October 1, 2015;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • 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 printable version of Form CFS2025 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS2025 "Home Safety Checklist for Intact and Permanency Workers" - Illinois

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CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
INSTRUCTIONS FOR COMPLETING THE HOME SAFETY CHECKLIST
Every year, 120,000 children 14 years of age and younger suffer some form of permanent damage due to unintentional/accidental injuries. Infants
and toddlers are at high risk of unintentional injury or death due to their inability to recognize and react to protect themselves from the danger.
According to data from the National SAFE KIDS Campaign:
Accidental or unintentional injury is the leading cause of death among children, teens and young adults.
The five leading causes of accidental injury are drowning, burns, motor vehicle accidents, falls, and poisonings.
Burns and fires are the fourth most common cause of accidental death in children.
Nearly 75 percent of all burns in children are preventable.
Nearly 2,900 adults and children die every year in fires or from other burn injuries.
The majority of children ages four and under, who are hospitalized for burn-related injures, suffer from scald burns (65 percent) or contact
burns (20 percent).
Hot tap water burns result in more deaths and hospitalizations than burns from any other hot liquids.
Fire/burns, motor vehicle traffic accidents, suffocation and accidental falls are the leading causes of unintentional deaths of children
under the age of five in Illinois. Numerous Illinois children also die each year as a result of domestic violence.
While it may be impossible to eliminate all the dangers children encounter in their homes, one of the most important factors in reducing those
dangers is parent education. The Home Safety Checklist, when properly used with parents and caregivers, provides an effective home safety
assessment and educational tool that will assist in promoting the safety of children.
WHEN TO COMPLETE THE CHECKLIST
Intact Family Cases
Intact Family Workers shall complete the Home Safety Checklist:
Within 30 days of the case opening regardless of whether a CFS 2027 was completed by a Child Protection Specialist;
Prior to a major change of life circumstance (e.g., move to a new home, child birth);
Every 90 days during the life of the case;
When a family with an open service case is the subject of a subsequent child abuse or neglect investigation; and
Within 5 calendar days of a supervisory approved case closure in conjunction with the final CERAP.
(1)
CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
INSTRUCTIONS FOR COMPLETING THE HOME SAFETY CHECKLIST
Every year, 120,000 children 14 years of age and younger suffer some form of permanent damage due to unintentional/accidental injuries. Infants
and toddlers are at high risk of unintentional injury or death due to their inability to recognize and react to protect themselves from the danger.
According to data from the National SAFE KIDS Campaign:
Accidental or unintentional injury is the leading cause of death among children, teens and young adults.
The five leading causes of accidental injury are drowning, burns, motor vehicle accidents, falls, and poisonings.
Burns and fires are the fourth most common cause of accidental death in children.
Nearly 75 percent of all burns in children are preventable.
Nearly 2,900 adults and children die every year in fires or from other burn injuries.
The majority of children ages four and under, who are hospitalized for burn-related injures, suffer from scald burns (65 percent) or contact
burns (20 percent).
Hot tap water burns result in more deaths and hospitalizations than burns from any other hot liquids.
Fire/burns, motor vehicle traffic accidents, suffocation and accidental falls are the leading causes of unintentional deaths of children
under the age of five in Illinois. Numerous Illinois children also die each year as a result of domestic violence.
While it may be impossible to eliminate all the dangers children encounter in their homes, one of the most important factors in reducing those
dangers is parent education. The Home Safety Checklist, when properly used with parents and caregivers, provides an effective home safety
assessment and educational tool that will assist in promoting the safety of children.
WHEN TO COMPLETE THE CHECKLIST
Intact Family Cases
Intact Family Workers shall complete the Home Safety Checklist:
Within 30 days of the case opening regardless of whether a CFS 2027 was completed by a Child Protection Specialist;
Prior to a major change of life circumstance (e.g., move to a new home, child birth);
Every 90 days during the life of the case;
When a family with an open service case is the subject of a subsequent child abuse or neglect investigation; and
Within 5 calendar days of a supervisory approved case closure in conjunction with the final CERAP.
(1)
CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
Subsequent CA/N Investigations of Families with Open Cases
The Child Protection Specialist or the Child Protection Supervisor shall notify the family assigned Intact Family or Permanency Worker or the
worker’s supervisor of the subsequent oral report (SOR) of alleged abuse or neglect within 48 hours after assignment of the investigation. The
notification shall include the reminder that the worker must complete a new checklist or re-certify the family’s previous checklist within 14 days
of the SOR. The Intact Family or Permanency Worker must also complete a case note that documents the worker’s current assessment of home
safety issues and forward the documentation to the Child Protection Specialist. The Child Protection Specialist cannot complete the investigation
without receipt of documentation that a checklist has been completed.
A Home Safety Checklist Waiver may be granted by the Intact Family Supervisor if the allegation or allegations of the SOR do not involve
inadequate shelter, inadequate supervision, substance misuse, environmental neglect, inadequate food or inadequate clothing. The supervisor must
complete a supervisory note documenting the waiver and rationale for the approval.
A Home Safety Checklist Recertification may be granted by the Intact Family Supervisor if the checklist was completed within six months of
the SOR; the SOR does not involve an allegation of inadequate supervision, inadequate food, inadequate clothing, inadequate shelter
environmental neglect or substance misuse; and the Intact Family Worker has completed a walk through of the family’s home to confirm that the
conditions of the home have not changed. The supervisor must complete a supervisory note documenting the approval and rationale for the
approval.
Placement Cases
Permanency Workers shall complete the Home Safety Checklist:
When a child is placed with an unlicensed relative. The assessment must be completed on the home of the relative;
When there is a child abuse or neglect investigation of an unlicensed home in which a child is placed;
Prior to a scheduled unsupervised visit in the home of the parents;
When there is a child abuse or neglect investigation involving an alleged incident that occurs during an unsupervised home visit;
Prior to placement of a pregnant or parenting teen in an independent living arrangement;
When a parenting teen is identified as the alleged perpetrator of abuse or neglect involving his or her child or any child residing in the
household;
Prior to implementation of child care arrangements involving a child for whom the Department is legally responsible when a parent or
caregiver plans to use an unlicensed day care home. The assessment must be completed on the day care home;
Prior to a major change of life circumstance (e.g., move to a new home, child birth);
Within 24 hours prior to returning a child home; and
Within 5 working days after a child is returned home and every month thereafter until the family case is closed.
A Home Safety Checklist waiver may be granted by the Permanency Supervisor if there is an SOR and the family does not have an open service
case with the Department; a checklist was completed for the family within 30 days; and the allegation or allegations of the SOR do not involve
inadequate shelter, inadequate supervision, substance misuse, environmental neglect, inadequate food, or inadequate clothing. The Permanency
Supervisor must complete a supervisory note documenting the waiver and rationale for the approval.
(2)
CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
A Home Safety Checklist Recertification may be granted by the Permanency Supervisor if the checklist was completed within six months of the
SOR; the SOR does not involve an allegation or allegations of inadequate shelter, inadequate supervision, substance misuse, environmental
neglect, inadequate food, inadequate clothing; and the Permanency Specialist has completed a walk through of the family’s home to confirm that
the conditions of the home have not changed. The Permanency Supervisor must complete a supervisory note documenting the approval for
recertification and the rationale for approval.
Note: When there is an allegation of inadequate shelter, inadequate supervision, substance misuse, environmental neglect, inadequate
food or inadequate clothing the checklist should be completed at the time the Safety Determination Form, CFS 1441, is completed.
HOW TO COMPLETE THE CHECKLIST
The Home Safety Checklist addresses fifteen categories of home safety. Each category is supported by safety standards, literature, and
straightforward factual information that should be shared with the parent/caregiver. Use the factual information and literature associated with each
category to establish an instructive dialogue to educate the family on safety issues.
There are three activities required for each standard:
1. Discuss the safety standard with the parent/caregiver;
2. Indicate the presence or absence of the safety standard; and
3. Provide the parent/caregiver with seven pieces of literature: PARENTS’ GUIDE to Fire Safety for Babies and Toddlers, A Helpful Guide
for Parents and Caregivers, Back to Sleep, Get water wise…SUPERVISE, Never Shake a Baby!, Practice Methadone Safety (only if
applicable) and Violence Prevention. This literature can be ordered from Central Stores.
Example: Once you have discussed the importance of having a working smoke detector and observed that the family has a smoke detector located
near their sleeping areas and the smoke detector works, circle “Yes” after the standard: The home has a working smoke detector located near
the family’s sleeping areas. If the family does not have a working smoke detector or has a smoke detector that does not work, circle “No”. A
“No” response requires a brief explanation in the Comments section.
When the parent/caregiver is provided fire safety literature, circle “Yes” to indicate that the required fire prevention literature was provided. The
Sleeping standard also requires a comment when a worker does not observe a crib or bassinette for infants age 1 or younger. Some standards are
age specific. For example, the standards that discuss burns may not be applicable to older children. When the standard does not apply circle
“N/A”.
When a standard requires the observation of a specific item or items (e.g., smoke detectors, small electrical appliances), the worker is required to
complete the task if the item is readily observable. Do not open cabinets or drawers, move furniture or handle dangerous items. On the last page of
the checklist there is a section to make additional comments or identify other hazards.
(3)
CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
The home safety assessment is a service provided to the children and families served by the Department. In order for the Home Safety Checklist
to be effective, the responsibility for its completion must be shared with the parent/caregiver. Use the information provided at the top of page one
of the instructions to explain the purpose of the assessment, provide the parent/caregiver a copy of the CFS 2026 or 2026-S (Spanish adaptation),
Home Safety Checklist for Parents and Caregivers, to use during the assessment, and to take notes on and retain for future reference. The
formats of the CFS 2027 and CFS2026/2026-S differ; use the prompts provided on the CFS 2027 to locate the corresponding CFS 2026/2026-S
sections. Sign, date and have the parent/caregiver sign the completed assessment. If the parent/caregiver declines the opportunity to complete the
checklist, check the declined box and request that the parent/caregiver verify his or her decision by signing the form. If the parent/caregiver
refuses to sign the form, document the negative response on the parent’s signature line. Place the completed assessment in the investigative local
index file.
Note: The CFS 2027 does not supersede any of the requirements for the completion of the CFS 1441 or CFS 454, HMR Placement Safety
Checklist.
Suggest that the family visit the following resources if they have Internet access:
American College of Emergency Physicians,
www.acep.org
American Association of Poison Control Centers,
http://www.aapcc.org
American Red Cross Health and Safety Services,
http://www.redcross.org
National Safe Kids Campaign,
http://www.safekids.org
American Human Society,
www.americanhumanesociety.org
American Veterinary Medical Association,
www.avma.org
Centers for Disease Control and Prevention,
www.cdc.gov
National Center for Injury Prevention and Control,
www.cdc.gov/injury/index
(4)
CFS 2025
State of Illinois
Revised 10/2015
Department of Children and Family Services
HOME SAFETY CHECKLIST FOR INTACT FAMILY AND PERMANENCY WORKERS
Date Checklist completed:
Parent / Caregiver Name(s):
Parent / Caregiver Address:
Names and ages of Children in the Home:
FIRE AND BURNS
Please circle your answers.
PARENTS’ GUIDE to Fire Safety for Babies and Toddlers
Literature Given:
Yes
No
A HELPFUL GUIDE for PARENTS and CAREGIVERS
Literature Given:
Yes
No
A functioning smoke detector was observed in the home.
Yes
No
Comments:
Discussed with parent?
Yes No
1. The home has a working smoke detector near the family’s sleeping areas.
2. The family has a fire escape plan that they practice so that they can react
Discussed with parent?
Yes No
quickly in case of a fire.
Young children in Illinois are more than three times as likely to die in a residential fire than the rest of the state’s population. Working smoke
detectors save lives! Instruct the family to change smoke detector batteries when they reset their clocks, SPRING AHEAD and FALL BACK.
Additionally, if the family/unlicensed caregiver does not have the means to purchase new or repair non-working smoke detectors, the
worker shall have the caregiver complete and sign the CFS 595-2, Consent for Installation of Smoke Alarm(s) form. The worker
shall fax the completed form as instructed on the bottom of the CFS 595-2. A smoke detector will be provided at no cost to the
parent/unlicensed caregiver.
These standards correspond to numbers 1 - 5 on the CFS 2026/2026-S.
(5)
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