Cpi-2 - Written Report Form For Mandated Reporters Of Child Abuse/neglect
Download a blank fillable Cpi-2 - Written Report Form For Mandated Reporters Of Child Abuse/neglect in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Cpi-2 - Written Report Form For Mandated Reporters Of Child Abuse/neglect with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Confidential
Department of Children and Family Services/Child Welfare
Written Report Form for Mandated Reporters of Child Abuse/Neglect
I understand that I am making a report of child abuse and/or neglect in good faith and in accordance with the Louisiana
Children’s Code, Article 610 D. which requires me, as a mandated reporter, to send a written report to the Department
of Children and Family Services (DCFS) or law enforcement within five days of having made an initial oral report. I
understand that I may report suspected abuse and/or neglect in writing instead of an oral report.
Use: This form is available for you to use to make a written report of child abuse and/or neglect to DCFS or law
enforcement. If you are unable to print out the form, contact any DCFS parish or regional office and one will be sent to
you.
Completion: Complete each item with information known by you that may be pertinent to the suspected
abuse/neglect. If there are items for which you have no information, please complete with “Unknown”. It is not
necessary for you to try and get all information requested. If you need more space, please add a page. Once
completed, it may be printed out and mailed or faxed to the DCFS office for the parish where the child lives or where
you made the report. The local offices, addresses and fax numbers are on this web site ( ). If you have
not yet made a report to DCFS, please fax this form as soon as possible. Thank you for your interest and
commitment to the safety and well being of children.
This Written Report is:
I nitial Written Report to DCFS
R eport to Law Enforcement
Follow-up to oral report to DCFS on:
to (Parish)
(Date)
DCFS Office
Is there any danger to a worker?
None known
Yes, Explain
Suspected Child Victim(s):
1. Name:
DOB/Age:
Race:
Sex:
2. Name:
DOB/Age:
Race:
Sex:
3. Name:
DOB/Age:
Race:
Sex:
Home Address:
Telephone:
Parents/Caretakers Names:
Others in Home:
Age:
Race:
Sex:
(Children & Adults
if known)
Age:
Race:
Sex:
Age:
Race:
Sex:
Age:
Race:
Sex:
Suspected Perpetrator(s):
Relationship to Child:
Suspected Perpetrator(s):
Relationship to Child:
Suspected Perpetrator’s Address:
Nature, extent and cause of each child’s injuries, neglect or endangered condition, including any previous
known or suspected abuse to this child or the child’s siblings:
Page 1
DCFS/CW Form CPI-2
Reissued: 01/12
Replacing: 6/08
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business