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Family Name:

Case No.:

Case Date:

Worker Name:	Family and Child Connect IFS (FaCC referral) IFS (direct referral) Agency name and catchment:
IFS Commencement Date:	Family Risk Re-evaluation Completion Date::
Re-evaluation No.: 1  2  3  4
Primary Parent:	Secondary Parent:
Is any child: Aboriginal Torres Strait Islander Both

		SCORE
R1.Number of prior Child Safety notifications
	a. Less then two b. Two or more
R2. Prior ongoing Child Safety intervention
	a. No b. Yes
R3. Was the child injured in the past due to child abuse/neglect
	a. No b. Yes
R4. Primary parent history as a child
	a. No history of abuse or neglect b. History of abuse or neglect
R5. Characteristics of children in the household
	a. No child has any of the characteristics listed below b. Any child in the household is: Developmentally or physically disabled Medically fragile or diagnosed with failure to thrive
R6. Child Safety involvement during this review period
	a. No new notification to Child Safety b. Child Safety notification occurred
R7. Parent alcohol or drug status during this review period
	a. No history of alcohol or drug misuse b. No current alcohol or drug misuse; no intervention needed c. Alcohol or drug misuse; problem is being addressed d. Alcohol or drug misuse; problem is not being addressed
R8. Household relationship status during this review period
	a. No domestic or family violence b. Domestic or family violence
R9. Primary parent physical care of child during this review period
	a. Consistent with child needs b. Inconsistent with child needs
R10 . Progress with the case plan (mark one based on the parent with the least progress)
	a. Not applicable; all services unavailable b. Achieved safety goal; or demonstrating actions of protection per plan over time c. Beginning to demonstrate actions of protection per plan, but inconsistent, or not over time d. Not demonstrating actions of protection per plan
TOTAL SCORE		0

OVERRIDE SECTION:

Policy override to high: Select yes if any condition is applicable; final risk level is high.
Yes No	1. Non-accidental injury to a child under age 3 years.
Yes No	2. Severe non-accidental injury by a parent.
Yes No	3. Parent caused death of a child due to abuse or neglect.

Discretionary override: