Family Assessment Checklist

Children, Adults and Families (Expedited, regular, update and

Foster Care Unit
pre-adoptive family assessment)

Steps completed PRIOR to placement:

CF 1260A - Application for Approval to Care for a Child in DHS Custody – (Including
verifying ID.)
Section A - EXPEDITED CERTIFICATION

Interviews - Contact with all available members of the household - Approval need for
household members not seen.
Child Welfare History (in state) - Check child welfare data systems.
Child Welfare History (out-of-state) request initiated - (If any history reported or applicant
lived outside OR in last five years.)
CF 1011f - LEDS/CCH check - (All household members aged 18 years and over; persons
under 18 years as necessary.)
CF 1011d - Criminal history exception - (If applicable)
CF 979 - Safety Assessment - Home and Surroundings - Assess all rooms in the home
and out-buildings
Applicant references - Two minimum. Documented on the SAFE reference form.
CF 117 - Obtain management approval - (If applicable)
SAFE Questionnaire One is given to the applicant(s) to complete within the next
several days.
SAFE home study template - First page completed and initialed by supervisor.
CF 1008a - Issue provisional certificate of approval after supervisor agrees.

Complete in addition to section A:

References – Obtain two additional for (4) minimum requirements. (Use SAFE
Section B –To Complete FULL CERTIFICATION

reference form.)
9800P - Orientation. (Review, in person with foster parents.)
Home visit - To interview and observe household members.
Administer SAFE Questionnaire Two and complete required interviews with primary adults.
Complete other interviews of persons living in the home if not done during home visits.
CF 1257A - Medical Report A
CF 1257B - Medical Report B (if applicable)
CF 1291 - Family Financial Report
Discuss and develop a training plan with the certified family.
CF 1258 - Mental Health form (if applicable)
CF 117 – Management approval (if applicable)
Criminal history check process complete including receipt of finger print results for all adult
household members.
CF 1011d – Criminal History Exception (if applicable)
SAFE home study template completed, approved and copy given to foster parents.
CF 1008 or 1008a – Issue Certificate of Approval after supervisor agrees.

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NOTE: A pre-adoptive home must be certified and remain certified until the adoption finalizes.

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 For Re-certification update:
Home Visit - Contact with all household members. (Can start process about 90 days before
Section C - RE-CERTIFICATION UPDATE

certification expires.)
CF 1001 - Certified Family Certificate: Renewal or change of status application.
Child Welfare History - in state - Check child welfare data systems.
CF 1011F - Complete a Criminal Records Check; if appropriate complete finger
printing process.
CF 979 - Safety Assessment - Home and Surroundings (Assess all rooms in the home and
out-buildings.)
CF 34 - training hours; confirm completion of required hours of training.
Training plan - Develop new training plan for the new certification period.
CF 117 - renew or obtain management approvals. (if applicable)
CF 1011d - Criminal history exception - (if applicable)
SAFE Update Home Study - Complete process including update questionnaire and PSI.
CF1008a or CF 1008 - Issue certificate of approval after supervisor approves.

A complete initial ADOPTION PACKET consists of the following:

CF 1260A - Application for approval to Care for a Child in DHS Custody.
Section D - ADOPTION PACKET

SAFE Applicant References - Four total (two can be from relatives). These expire every
24 months.
SAFE home study (initial) - (Must be updated every 12 months.)
SAFE home study updates and all other updates if any.
Marriage verification (if applicable)
Divorce verification (if applicable)
Death verification (if applicable)
CF 1257 A & B - Medical forms (Updated every 24 months.)
CF 1266 - Adoptive Family Information and Placement Preference (General applicant only.)
CF 1011F Criminal History Checks - redo checks every 12 months while family is waiting
for a placement.
CF 1291 Financial report - (Updated every 24 months.)

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