BROWARD COUNTYSHERIFF’S OFFICE

Child Protective Investigations Section

359 North State Road 7

Plantation, FL 33317 (954) 797-5299

CONFIDENTIAL

Case Staffing Document

Last Name of Children:
/ Last Face-to Face Visit Completed:
No Yes, Date:
Abuse Report No.:
/ Date Submitted:
Child Protective Investigator:
/ Cell Phone:
/ Office:
/ Pager:
Supervisor’s Name:
/ Cell Phone:
/ Office:
/ Pager:
Choose One:
New Dependency Case
Existing Dependency Case: Judicial Case No: CJ-DP
Add-on of additional sibling to :Judicial Case No: CJ-DP
Choose One:
ShelterVPSReferral for ServicesConsultation
Straight Petition for AdjudicationRe-OpenSua Sponte
Other(Question #3 must be answered):
Yes No - This case appears appropriate for referral to Dependency Drug Court.
Yes No - This case has children or parents who may be subject to Indian Child Welfare Act
Yes No - This case has sexual exploitation that meets Human Trafficking designation?
Yes No -Does case involve person(s) needing communication assistance?
Check all applicable: Deaf or hard of hearing ; Visually impaired ; Limited English Proficiency
Name: Child ; Mother ; Father ; Caregiver/Other
Documents:
Check all that exist. Provide these documents initially to the OAG if filing and as they become available through the ongoing Investigation.
Number of Abuse Reports: (Copies of all current and prior reports must be attached. Submitted by statute to the court at the shelter hearing)
Type / Date / Type / Date
Medical Records/Reports / SATC/CPT Reports
PDA or CSA / Additional Witness List
Current/Prior Case Plans / Juvenile Delinquency History
LEO/Police Report(s) / Chronological Notes
Child(ren) Photographs / Home Photographs
Present or Impending Danger Safety Plan / FFA
Copy of file is to be provided to OAG. Document when provided:
A check of CCIS (Florida Comprehensive statewide court information system) found the following:
Choose One:
There are no related cases.
The following are the related cases (add additional pages if necessary) Please attach documentation.
Related Case No. 1
Case Name(s)
Petitioner:
Respondent:
Case No.: / Division:
Type of Proceeding: (Check all that apply)
Dissolution of Marriage Mental Health
Custody Paternity
Child Support Adoption
Juvenile Dependency Modification/Enforcement/Contempt Proceedings
Termination of Parental Rights Juvenile Delinquency
Domestic/Sexual/Daring/Repeat Criminal
Violence Injunctions Temporary Relative / Kinship Case
Other (specify)______
State where case was decided or is pending:
Florida Other (specify)______
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion County, Florida)
Title of Last Court Order / Judgment (if any)
Date of Court Order/Judgment (if any)
Relationship of Cases (Check all that apply)
pending case involves same parties, children, or issues; may affect court’s jurisdiction;
order in related case may conflict with an order in this case; order in this case may conflict with previous order in related case
Statement as to the relationship of the cases:
Related Case No. 2
Case Name(s)
Petitioner:
Respondent:
Case No.: / Division:
Type of Proceeding: (Check all that apply)
Dissolution of Marriage Mental Health
Custody Paternity
Child Support Adoption
Juvenile Dependency Modification/Enforcement/Contempt Proceedings
Termination of Parental Rights Juvenile Delinquency
Domestic/Sexual/Daring/Repeat Criminal
Violence Injunctions Other (specify)______
State where case was decided or is pending:
Florida Other (specify)______
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion County, Florida)
Title of Last Court Order / Judgment (if any)
Date of Court Order/Judgment (if any)
Relationship of Cases (Check all that apply)
pending case involves same parties, children, or issues; may affect court’s jurisdiction;
order in related case may conflict with an order in this case; order in this case may conflict with previous order in related case
Statement as to the relationship of the cases:
Related Case No. 3
Case Name(s)
Petitioner:
Respondent:
Case No.: / Division:
Type of Proceeding: (Check all that apply)
Dissolution of Marriage Mental Health
Custody Paternity
Child Support Adoption
Juvenile Dependency Modification/Enforcement/Contempt Proceedings
Termination of Parental Rights Juvenile Delinquency
Domestic/Sexual/Daring/Repeat Criminal
Violence Injunctions Other (specify)______
State where case was decided or is pending:
Florida Other (specify)______
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion County, Florida)
Title of Last Court Order / Judgment (if any)
Date of Court Order/Judgment (if any)
Relationship of Cases (Check all that apply)
pending case involves same parties, children, or issues; may affect court’s jurisdiction;
order in related case may conflict with an order in this case; order in this case may conflict with previous order in related case
Statement as to the relationship of the cases:
Related Case No. 4
Case Name(s)
Petitioner:
Respondent:
Case No.: / Division:
Type of Proceeding: (Check all that apply)
Dissolution of Marriage Mental Health
Custody Paternity
Child Support Adoption
Juvenile Dependency Modification/Enforcement/Contempt Proceedings
Termination of Parental Rights Juvenile Delinquency
Domestic/Sexual/Daring/Repeat Criminal
Violence Injunctions Other (specify)______
State where case was decided or is pending:
Florida Other (specify)______
Name of Court where case was decided or is pending (for example, Fifth Circuit Court, Marion County, Florida)
Title of Last Court Order / Judgment (if any)
Date of Court Order/Judgment (if any)
Relationship of Cases (Check all that apply)
pending case involves same parties, children, or issues; may affect court’s jurisdiction;
order in related case may conflict with an order in this case; order in this case may conflict with previous order in related case
Statement as to the relationship of the cases:
Choose One:
I do not request coordination of litigation in any of the cases listed above.
I do request coordination of the following cases:
Check all that apply:
Assignment to one judge
Coordination of existing cases will conserve judicial resources and promote an efficient determination of these cases
because:
CHILDREN’S INFORMATION
Children’s Information (Required by Law); All children in the home must be listed
Legal Name / Medical Needs/all medications & dosages / Race / Sex / DOB / SSN / Place of Birth / Was mother married at the time of conception?
If yes, to whom/ Date of Marriage / Name of Mother / Name of Father
Residence of Child (ren) for the past five years(Required by Law)
Address: / From / To / Adult(s) with whom child(ren) resided:
PARENT’S INFORMATION
MOTHER
Mother’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was mother notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
What information did she provide?
FATHER: Pick one: Married Birth (per Birth Certificate / Attach) Alleged
Father’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Child’s Name: / Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
FATHER Pick one: Married Birth (per Birth Certificate / Attach) Alleged
Father’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Child’s Name: / Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
FATHER Pick one: Married Birth (per Birth Certificate / Attach) Alleged
Father’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Child’s Name: / Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
FATHER Pick one: Married Birth (per Birth Certificate / Attach) Alleged
Father’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Child’s Name: / Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
FATHER Pick one: Married Birth (per Birth Certificate / Attach) Alleged
Father’s Legal Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Child’s Name: / Address:
If, location unknown has diligentsearch begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
LEGAL GUARDIAN/CUSTODIAN INFORMATION (This is only needed if other than parent)
Legal Guardian/Custodian Name:
/ Date of Birth:
/ SSN#:
/ Home Phone:
/ Cell Phone:
Address:
If, location unknown has diligent search begun? No Yes, Date:
If location unknown, Inquiry was made of the following person(s) to locate to date:
Criminal History: No Yes, If yes explain:
Inmate Number (if applicable):
/ If incarcerated, where?
/ Need to be ordered from facility:
No Yes
Was father notified about shelter hearing?
No Yes / How?
By Phone In Person Other:
Does legal guardian/custodian know the identity and whereabouts of the parents? No Yes
What information did he/she provide?
Basis for Guardianship: Kinship Court Order Private Agreement Other:

* Court Order granting custody or guardianship should be obtained and attached

ALLEGED PERSON RESPONSIBLE INFORMATION
PERSON RESPONSIBLE
Person responsible Name:
/ Relationship to child(ren):
Was Perpetrator arrested?
No Yes, If yes answer the following: / Inmate#:
/ If incarcerated where? (facility)
Charges:
Law Enforcement (LE) Agency:
/ District:
/ Agency Case#:
/ LE Name / ID#:
/ LE Phone #:
LE Offense Report Attached? Yes No, If not, why?
PERSON RESPONSIBLE
Person responsible Name:
/ Relationship to child(ren):
Was Perpetrator arrested?
No Yes, If yes answer the following: / Inmate#:
/ If incarcerated where? (facility)
Charges:
Law Enforcement (LE) Agency:
/ District:
/ Agency Case#:
/ LE Name / ID#:
/ LE Phone #:
LE Offense Report Attached? Yes No, If not, why?
VICTIM CHILD INFORMATION
VICTIM CHILD
Victim Child Name:
/ # of Photos:
/ Type of Photos:
/ Taken By:
Date Photos Taken:
/ Description of Content:
Medical Exams? No Yes, If yes, by whom?
CPT SATC Hospital Private / Date:
/ Where:
Examiner’s Name:
/ Title:
/ Phone #:
Diagnosis / Impressions:
Description of Injury:
Does Examiner feel condition is due to abuse / neglect?
No Yes / Type:
Does Examiner or their agency have recommendations as to placement: No Yes, If yes, with whom:
Protective Investigators recommendation as to placement:
VICTIM CHILD
Victim Child Name:
/ # of Photos:
/ Type of Photos:
/ Taken By:
Date Photos Taken:
/ Description of Content:
Medical Exams? No Yes, If yes, by whom?
CPT SATC Hospital Private / Date:
/ Where:
Examiner’s Name:
/ Title:
/ Phone #:
Diagnosis / Impressions:
Description of Injury:
Does Examiner feel condition is due to abuse / neglect?
No Yes / Type:
Does Examiner or their agency have recommendations as to placement: No Yes, If yes, with whom:
Protective Investigators recommendation as to placement:
VICTIM CHILD
Victim Child Name:
/ # of Photos:
/ Type of Photos:
/ Taken By:
Date Photos Taken:
/ Description of Content:
Medical Exams? No Yes, If yes, by whom?
CPT SATC Hospital Private / Date:
/ Where:
Examiner’s Name:
/ Title:
/ Phone #:
Diagnosis / Impressions:
Description of Injury:
Does Examiner feel condition is due to abuse / neglect?
No Yes / Type:
Does Examiner or their agency have recommendations as to placement: No Yes, If yes, with whom:
Protective Investigators recommendation as to placement:
MALTREATMENT FINDINGS
Complete the following section thoroughly for the OAG to properly prepare your petition. You must state all the supportive evidence and corresponding findings of maltreatment to be included within your petition.
Include all of the allegations in the Abuse Report and respective findings: verified; some indicators or no indicators.
Include additional safety factors you have discovered in your investigation. Do Not Say, “See Abuse Report” - You must be as specific as possible and provide all supporting documentation or sources of information that would assist in the preparation of this document.
The child(ren) have been abused, neglected or abandoned, describe:
The child(ren) is/are abused, neglected, or abandoned and is suffering from or is in imminent danger [On emergency removal describe]:
Choose All That Apply:
The continuation in the home is contrary to the welfare of the children because the home situation presents a substantial and immediate danger which cannot be mitigated by provision of preventive services and placement is needed to protect the children specifically
The children are abused/neglected/or abandoned or is/are suffering from or in imminent danger of injury or illness as a result of abuse, neglect, or abandonment, specifically:
The children are dependent children by previous order of the court and the custodian has materially violated a condition of placement imposed by the court, specifically:
The children has/have no parent, legal custodian, or suitable, responsible adult relative immediately known and available to provide supervision and care, specifically:

*Please provide additional information on a separate sheet if necessary.

CHILD SAFETY ASSESSMENT
Initial Safety Assessment completed: / Date: / Time:
Safety Assessment to include abuse, neglect, harm findings and severity both present and past; all other risk factors; vulnerabilities; parents/custodian’s ability to protect, cooperate, address issues.
  1. Did CPI find Present Danger: immediate, significant and clearly observable family condition occurring in the present tense, already endangering or threatening to endanger the child or children? Yes/No
  1. If the CPI is completing the investigation under the new Florida Safety Decision Making Methodology (FSDMM) has the Family Functioning Assessment (FFA) been completed? Yes/No (provide to OAG)
  1. If FFA is completed are there Identified present or impending danger threats? Yes/No
  1. If there are danger threats: Is there a vulnerable child & insufficient parent protective capacities to manage the danger threat(s) rendering the child unsafe? Yes/No

Did the determinations show a clear and present need for formal protection afforded by protective supervision?
No Yes, please outline safety concerns below:
Identify the listed danger threats below that apply:
1. Parent/Legal Guardian/Caregiver is not meeting child’s basic and essential needs for food, clothing and/or supervision, AND child is/has already been seriously harmed or will likely be serious harmed.
2. Parent/Legal Guardian/Caregiver’s intentional and willful act caused serious physical injury to the child, or the caregiver intended to seriously injury the child
3. Parent/Legal Guardian/Caregiver is violent, impulsive, or acting dangerously in ways that have seriously harmed the child or will likely seriously harm the child.
4. Parent/Legal Guardian/Caregiver is threatening to seriously harm the child; Parent/Legal Guardian is fearful he/she will seriously harm the child.
5. Parent/Legal Guardian/Caregiver views child and/or acts toward the child in extremely negative ways AND such behavior has or will result in serious harm to the child.
6. Child shows serious emotional symptoms requiring immediate intervention and/or lacks behavioral control and/or exhibits self-destructive behavior that parent/legal guardian/caregiver is unwilling or unable to manage.
7. Child has a serious illness or injury (indicative of child abuse) that is unexplained, or the Parent/Legal Guardian/Caregiver explanations are inconsistent with the illness or injury.
8. The child’s physical living conditions are hazardous and a child has already been seriously injured or will likely be seriously injured. The living conditions seriously endanger a child’s physical health.
9. There are reports of serious harm and the child’s whereabouts cannot be ascertained and/or there is a reason to believe that the family is about to flee to avoid agency intervention and/or refuses access to the child and the reported concern is significant and indicates serious harm.
10. Parent/Legal Guardian/Caregiver is not meeting the child’s essential medical needs AND the child is/has already been seriously harmed or will likely be seriously harmed.
11. Other (with supervisory approval) List the specific other:
Vulnerabilities and other factors that impact safety/risk:
Young parents? Ages: / No Yes
Domestic violence? / No Yes
Drug abuse? / No Yes
Criminal history that poses threat? / No Yes
Prior reports involving subjects? / No Yes
Pattern continuing or increasing? / No Yes
Physical or sexual abuse & person responsible in home or unknown? / No Yes
Is there a non-offending caregiver unable or unwilling to protect? / No Yes
Person’s biologically unrelated regularly visit or in household? / No Yes
Caregiver describes or acts towards child in predominately negative terms? / No Yes
Caregiver has made plausible threat that would result in harm to child? / No Yes
Caregiver has not met or is unable to meet immediate needs for food, clothing, shelter, health care, or protection from harm? / No Yes
Caregiver has apparent mental health, drug or alcohol issue affecting ability to adequate provide care? / No Yes
Maltreatment severity – (i.e.: crack house or similar environment, inflicted injuries, sexual abuse, failure to thrive, head trauma, death, extreme bizarre punishment or confinement?) / No Yes
Child is 4 years old or younger, or non-verbal, or unwilling to cooperate? / No Yes
Reason to believe family is about to flee, or refuse or limit access to child (ren)? / No Yes
Child (ren) has/have developmental, physical, emotional, or medical condition that increases vulnerability? / No Yes
Child (ren) stay in a place with hazardous physical living conditions? / No Yes
Child (ren) exhibits behaviors indicative of abuse / neglect? (i.e.: excessive school absenteeism, fear of caregiver, suicidal thoughts or threats, runs away, age-inappropriate sexual behavior, harm to self, etc.): / No Yes,
If yes, please describe:
The nature, extent and the circumstances surrounding the maltreatment? (This may be cut/paste from FFA)
VOLUNTARY SERVICES
Were Voluntary Services offered / accepted by the parents for this Abuse Report?
Yes, What services and with what result at this time?
Date of Referral: Provider: Phone: Copy of Referral Attached: Yes No
No, Why?
If this case involves a new sibling on an existing judicial case, state what the progress of the parent(s) on their case plan is in regard to the other children as well as where those children are currently placed.
Has the caseworker been contacted? No Yes
What is their view?
PRIOR ABUSE REPORTS
Nature of Prior Reports and Outcome: (Please Provide Copies of the Priors to OAG with the Case Opening Document)
Abuse Report Number / Maltreatment / Findings / Outcome
REMOVAL AND PLACEMENT INFORMATION
The child(ren) was/were removed: / Date:
/ Time:
/ From:
Address:
Investigator:
Shelter Placement: ChildNet Relative Non-relative DJJ Runaway Absentia
If relative or non-relative placement complete the following:
Name:
/ Name of Child:
/ Relationship to Child(ren):
Address:
/ Phone:
Shelter Placement: ChildNet Relative Non-relative DJJ Runaway Absentia
If relative or non-relative placement complete the following:
Name:
/ Name of Child:
/ Relationship to Child(ren):
Address:
/ Phone:
Alternate Placements Explored:
Name:
/ Relationship to Child(ren):
/ Date Contacted:
/ Phone:
Projected Completion of Home Study:
Findings:
Alternate Placements Explored: (continued)
Name:
/ Relationship to Child(ren):
/ Date Contacted:
/ Phone:
Projected Completion of Home Study:
Findings:
Possible Relative/Non-Relative Placement: / Telephone Number:
HOMESTUDY AND BACKGROUND CHECK INFORMATION
Home Study Completed: No Yes Pending / Provided at staffing: No Yes
If yes, Results / If Pending expected date for completion:
FCIC, NCIC, Abuse Registry and Sexual Predator checks completed on the following persons who reside in the placement home and results attached: No Yes
WITNESS LIST FOR ADJUICATORY HEARINGS
Witness 1
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 2
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 3
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 4
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 5
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 6
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:
Witness 7
Name:
/ Relationship to victim child(ren)?:
/ Telephone:
Address:

*If additional space is necessary, please attach a separate sheet to provide the above Information.