Form CFS687 "Sexual Abuse Program Summary of Review and Screening" - Illinois

What Is Form CFS687?

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 January 1, 2007;
  • 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 fillable version of Form CFS687 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 CFS687 "Sexual Abuse Program Summary of Review and Screening" - Illinois

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CFS 687
State of Illinois
Rev. 1/2007
Department of Children and Family Services
SEXUAL ABUSE PROGRAM
SUMMARY OF REVIEW AND SCREENING
Filing Instructions: Upon completion, the CFS 687 Summary of Review and Screening is to be filed in
Section VI Child Specific Section of the case record.
I.
UIR REVIEW
UIR #
DATE FILED:
DATE RECEIVED:
Name:
ID#:
DOB:
Male
Female
Primary language:
Legal status:
Persons
Relationship
Contacted
to Child
Date
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
Reporter:
Worker:
R/S/F:
Supervisor:
CPSW investigation conducted?
Yes
No
If yes, outcome:
Indicated
Date
Unfounded
Date
Pending as of
(Date)
Investigator:
Investigating Unit:
Investigation by law enforcement?
Yes
No
If yes, name of law enforcement / investigating unit:
1
CFS 687
State of Illinois
Rev. 1/2007
Department of Children and Family Services
SEXUAL ABUSE PROGRAM
SUMMARY OF REVIEW AND SCREENING
Filing Instructions: Upon completion, the CFS 687 Summary of Review and Screening is to be filed in
Section VI Child Specific Section of the case record.
I.
UIR REVIEW
UIR #
DATE FILED:
DATE RECEIVED:
Name:
ID#:
DOB:
Male
Female
Primary language:
Legal status:
Persons
Relationship
Contacted
to Child
Date
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
Reporter:
Worker:
R/S/F:
Supervisor:
CPSW investigation conducted?
Yes
No
If yes, outcome:
Indicated
Date
Unfounded
Date
Pending as of
(Date)
Investigator:
Investigating Unit:
Investigation by law enforcement?
Yes
No
If yes, name of law enforcement / investigating unit:
1
Criminal charges filed for sexual offense?
Yes
No
Date charged:
Pending as of
(Date)
What was the charge?
Adjudicated
Charges pled down from
to
Charges dropped
Dependency
Court of jurisdiction:
List all of the court’s orders regarding this offense or violation:
Was the ward placed on probation as a result of this offense?
Yes
No
If yes, list the conditions of probation:
SASC NOTES: Summary of Contacts/Findings
(Include reason for disposition determination.)
2
DISPOSITION
NOT A SEXUAL BEHAVIOR PROBLEM.
PROCEED WITH BEHAVIORAL REVIEW.
RECOMMENDATIONS
For caseworker / supervisor:
For caregiver:
Completed by:
Date:
3
II.
BEHAVIORAL SCREENING
INFORMATION REVIEWED
PARTICIPANTS
Participants
Relationship
Name
to Ward
Date
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
In person
By phone
BACKGROUND INFORMATION
Reason/Date(s) for DCFS involvement:
Permanency plan:
How often is family and/or sibling visitation occurring?
If family / sibling visitation are not ongoing, reason why:
Worker’s knowledge of case:
Worker’s knowledge of alleged sexual incident:
4
ALLEGED SEXUAL INCIDENT
Date of incident:
UIR #:
Describe the behavior:
Describe the precursors/antecedents to the incident:
Describe the context in which the incident occurred:
The incident was witnessed by:
What time of day did the alleged incident occur?
Ward’s age at time of alleged incident:
How was the sexual incident discovered? Another child’s report? Observed by the caregiver or a
teacher? What documentation is there of the alleged incident, for example, case notes. school report,
eyewitness?
5
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