Child Protection Manual Forms
Forms and documents are located under section headings. The sections are detailed below with a list of documents contained in each section and subsection. The section or subsection link will take you directly to the relevant section folder on the SharePoint site. Please note that individual documents are not directly linked from the manual.
Case contracting
- Letter of advice re case management service from NGO
- Additional Report by another Agency in Support of Application to extend
- Quarterly report from contracted agency
- Agreement with another agency for provision of case management
- Letter of request to NGO re Quarterly Report
Case planning
- Invitation to case planning meeting - client
- Invitation to case planning meeting - parent
- Invitation to case planning meeting - other
- Case plan template
- Request for a review of a Child Protection decision
- Child and family cultural details
- Case plan actions table document
- Cover letter- change to nature of order - child
- Cover letter- change to nature of order - parent
- Cover letter- change to nature of order - court
- Direction to resume parenting responsibility s288A and s289A
- Principal practitioner consultation
- Transfer of case management responsibility
- Family preservation and reunification package guidelines
Case templates
- Areas of concern
- Responsible for harm assessment
- Unable to allocate CP worker
- Client overview
- Meeting minutes
- Child / Young Person's Profile
- Closure Summary
- Transfer Summary
- Letter general
- Form 6 Sch2 Notice of Direction under section 282(2)
- Placement referral
- Letter to support application for birth certificate
Consents
- Approval to grant a passport and travel abroad
- Authority to place a child in out of home care or a secure welfare service
- Sec 597(3) Consent for medical treatment/admission to hospital FRO/CBSO
- Sec 597(4) Consent for medical treatment/admission to hospital - emergency care/ IAO
- Consent to disclose to family
- Consent for medical examination under section 597(1)
- Consent for termination of pregnancy
- Permission to participate in an activity
- Permission to travel interstate
Court
- Affidavit or Declaration of service of a protection application
- Affidavit in support of an application to issue a Children's Court search warrant
- Form 21 Affidavit or Declaration of service of witness summons
- Agreement by child protection operations manager for appeal to the county court
- Form 58A & 58B Supreme Court appeals
- Family division - Notice of appeal
- Form 1 Application for a temporary assessment order ss.228 & 229
- Form 3 Application to vary or revoke temporary assessment order without notice s.235
- Form 10 Protection Application ss.240 & 243
- Form 10 page 2 Affidavit/Declaration or service of PA
- Statement of grounds
- Protection application information sheet
- Summary information form
- Application for conciliation counselling under s.260(1)
- Letter - application for conciliation counselling – information
- Certificate of Conciliation s260(2)
- Form 11 Irreconcilable differences application ss.259 & 260
- Form 12 Interim Accommodation Order - Bail Justice
- Form 13 Statement of placement availability pursuant to ss.263(1)(f) & (g)
- Form 14 Application to Vary an Interim Accommodation Order or for a new Interim Accommodation Order ss. 268, 270
- Form 15 Application to vary an Interim Accommodation Order or for a new Interim Accommodation Order - Interim Accommodation Order made under section 262 (1) (c) ss.268 & 270
- Form 16 Notice of Hearing - Breach of an Interim Accommodation Order s.269
- Form 17 Notice of Hearing - Breach of an Interim Accommodation Order made under section 262 (1) (C) s. 269
- Notice of hearing - breach of IAO (did not appear for therapeutic treatment order hearing)
- Form 20 Application to vary or revoke an undertaking ss.273 & 279
- Form 23 Application for care by Secretary order s. 289 (1a)
- Form 25 Application for long-term care order s. 290 (1a)
- Form 27 Application for Extension of a Protection Order ss.293 & 294
- Form 28 Application to vary or revoke a FPO or FRO ss. 300, 304
- Form 29 Application to vary a Family Reunification Order without notice s. 300a
- Form 30 Application to revoke a Care by Secretary order s. 305
- Form 31 Application to revoke a long-term care order s. 306
- Form 32 Application to include conditions in a family preservation order (where Care by Secretary order taken to be a Family Preservation Order) s. 289A(3)
- Form 33 Application for a Permanent Care Order s. 320
- Form 35 Application to vary or revoke a Permanent Care Order s. 326
- Form 36 Application for leave of the Court to make application to vary or revoke a permanent care order
- Form 37 Notice of hearing - breach of a family preservation order ss.312
- Form 38 Application to restrict access to a Report pursuant to ss.556, 559, 566 & 570
- Form 41 witness Summons to attend to give evidence
- Form 41A witness summons to produce
- Form 41B witness summons to produce and attend to give evidence
- From 45 General Application
- Gaol order (child)
- Goal order (adult)
- Interpreter form notice - court users
- Interpreter request form
- Conditions (pink) form
- Minutes (blue) form
- Appointment of an ICL (orange) form
- Minutes supplementary (mauve) form
- Court activity case note
- To parent re outcome of court hearing
- Written undertaking by a Suitable Person
- Application to Dispense with service s.531
- Letter, Advice re s350(2) CP Investigation - Court
- Letter to Children's Court regarding PA in the Family Division under s.351
- Letter, consent from parents - application to extend FRO/CBSO
- To parent re lapse of protection order
- To parent of placement change for a client subject to an IAO
- To court of placement change for a client subject to an IAO
- Directions hearing form
- CC Addendum Report
- Addendum Report*
- Confidential Court Report - Breach/Extend/Vary/Revoke*
- Temporary Assessment Order Court Report Document
- To parent re withholding of partial/all court report
- Confidential Court Report - Protection Report*
- Confidential Court Report - Disposition Report*
- Protection application report
- Recommendations reportUpdate report
- Report in support of application to extend/breach/vary/revoke
- Report in support of application of CBSO or LTCO
- Report in support of application of PCO
- Court report writing guide
* Can only to be used for applications made before 28 March 2020.
- Search warrant ss241, 243, 261, 291,313, and 314
- Search warrant s247
- Search warrant s268
- Search warrant s269
- Search warrant s270
- Search warrant s598(1)(a)
- Search warrant s.237
- Search warrant s.598(1)(b) or (c)
- Request to Police re Cancel a Missing Persons Report
- Request to Police re Cancel a Children's Court Search Warrant
- S67ZBG Template
- S67ZBE Tip Sheet
- S67ZBD Tip Sheet
- S67ZBE Template
- Federal Circuit and Family Court of Australia - Request for Information Form
- S67Z Template- response to Notice of child abuse, family violence or risk.
- S67ZA Template- response to report made under S67ZA of the Family Law Act 1975
- S67ZBD Template
- S67ZBG Tip Sheet
- Report re child exclusion condition on family violence intervention order
- Report re child exclusion condition on personal safety intervention order
- Child Protection entry report to Family Drug Treatment Court
- Weekly update report to Family Drug Treatment Court
- Advice to Family Court re 67z - general
- Advice to Family Court re 67z - incomplete
- Advice to Family Court re 67z – parent
Family violence
- Specialist family violence worker consultation template
- Specialist family violence worker statistics sheet
- Safety plan adult - family violence
- Safety Plan adult - general
- Safety plan child
High risk and Infant Intensive Response
High risk and Infant Intensive Response link
- Schedule of High Risk Adolescents
- Sexual exploitation information template
- After Hour Service Possible Contact
- Secure welfare services placement record
- No contact letter
- IIR meeting template
- IIR panel template
- IIR panel terms of reference
Information sharing and requests
Information sharing and requests
- Authorisation to receive information under s.206(2)(f)
- Notice of consent to release information
- S192 Voluntary request for disclosure letter
- Centrelink in touch program
- Centrelink information request
- Child Support information request
- Medicare information request
- Medicare for children and young people in out-of-home care - fact sheet
- Notice of direction to disclose information
- Request to Family Court for information
- Information sharing between DHHS and the Magistrates' Court and Children's Court- information sheet
- Information sharing request from Child Protection to Magistrates Court/Children's Court Victoria
- Response to information sharing request from Magistrates' Court/Children's Court Victoria
- NDIS consent to exchange information form
- NDIS Information request form
Intake
- Letter - intake advice to reporter
- Letter - intake advice to families (outcome)
- Intake case conference record
- Intake case conference report
- Intake record
- Intake record via court report request
- Intake via conciliation counselling request
- Intake via Hague Convention request
- Intake via refugee minor
- Intake via report on Unborn
- Intake for SOS voluntary client
- Intake report manage permanent care order
- Intake via interstate request
- L17 Family Violence Portal Operational Manual
Interstate liaison
- Request for interstate notification alert
- Request for interstate assessment of carer
- Request for interstate assessment of carer for holiday placement
- Request for interstate transfer of casework assistance
- Acceptance of transfer of casework
- Request to locate an interstate placement
- Request for interstate child protection information
- Request for interstate assessment of parents for reunification
- Request for interstate order/proceedings
- Request for interstate transfer of Child protection order or proceedings
- Letter to Victoria Children's Court re transfer of proceedings to another state
- Letter to child advising decision to transfer order interstate and right to appeal - Administrative transfer
- Letter to parents advising decision to transfer order interstate and right to appeal - Administrative transfer
- Parental consent to transfer order interstate - administrative transfer
- Letter to interstate CP advising no appeal lodged re judicial order/proceedings transfer
- Letter to interstate CP advising appeal lodged re order/proceedings transfer
- Letter to interstate CP advising outcome of appeal
- Request for consent for interstate transfer
- Letter to Victoria Children's Court re judicial transfer of order to another state
- Letter to interstate CP seeking to withdraw request
- Application to transfer a pending Child Protection proceedings from Victoria to another jurisdiction
- Application to Transfer Child Protection Order from Victoria to another Jurisdiction
- Certificate under clause 3(1)(e) of Schedule 1 that child has had opportunity to seek legal advice
- Advice to interstate CP of decision for administrative transfer of child protection order
- Declaration of exclusive parental rights
- Application to court to register interstate order in Victoria
- Letter to parent advising interstate order/proceedings registered in Victoria
- Letter to interstate CP - decline request for transfer of order/proceedings
- Letter to interstate CP - consent/accept request for transfer of order/proceedings
- Letter to child advising interstate order/proceedings registered in Victoria
- Application to Court to register interstate Child Protection proceedings in Victoria
Investigation
- First visit case notes
- Investigation outcome summary
- Letter of closure post investigation - to parent
- Letter of closure post investigation - to client
- Investigation plan
- Substantiation letter to parent
New allegation
- New allegation familial harm
- New allegation non familial abuse
Out-of-home care
- Carer authorisation instrument IAO FRO
- Carer authorisation instrument CBSO LTCO
- Letter to carer authorisation
- Carer authorisation letter to parents IAO FRO
- Letter to parent re carer authorisation – CBSO LTCO
- Carer authorisation cover letter to carers extension
- Carer authorisation cover letter to carers revoking
- Carer authorisation letter to schools re extension
- Carer authorisation letter to schools re revocation
- Caregiver Registration - Create & Change
- Caregiver reimbursement - cease
- Caregiver reimbursement - change of details
- Caregiver reimbursement - commence or commence and cease
- Application for direct debit
- Counting time in OoHC
- Evidence of time in OoHC
- Instructions for time in OoHC calculator
- Time in OoHC calculator
- Time in OoHC diagram
- Cross border placement agreement
- Cross border placement - information for carers
- Individual education plan template
- Letter to principal re child in oohc
- Local Government Areas contact list for child protection
- Notifying LGA when children enters oohc
- LGA proforma letter 2021
- DET Education Facility list October 2021
- Kinship carer assessment report template (Part A)
- Kinship carer assessment report template (Part B)
- Kinship carer assessment report template (Part C)
- Letter to Centrelink re change to care arrangements
- Kinship care placements - approval of placement
- Kinship care placements – assessment report
- Kinship care placement agreement parent
- Form 4 - Kinship assessment for permanent care
- Essential information record
- Child/Young Persons Care and Placement Plan
- Care and Placement Plan Review
- Assessment & progress record - under 1 (pdf, 1.08 MB)
- Assessment & progress record - 1 to 2 (pdf, 1.25 MB)
- Assessment & progress record - 3 to 4 (pdf, 1.28 MB)
- Assessment & progress record - 5 to 9 (pdf, 1.37 MB)
- Assessment & progress record - 10 to 14 (pdf, 17.96 MB)
- Assessment & progress record - 15+ (pdf, 22.58 MB)
- 15+ Care and transition form (pdf, 208.11 KB)
- Form 1 - Case planning consultation for permanent care team
- Form 2 - Child protection referral for permanent care team
- Form 3 - Child assessment for permanent care
- Form 5 - Foster care conversion to permanent care assessment
- Form 6 - New permanent care assessment
- Form 7 - Enquiry about permanent care
- Form 8 - Letter to permanent care applicants following expression of interest
- Form 9 - Expression of interest to attend permanent care training
- Form 10 - Permanent care application form
- Form 11 - Letter to new permanent care applicants - health, referees and life stories
- Form 12 - Letter to general practitioner
- Form 12a - Medical assessment for prospective permanent carers
- Form 12b - Medical assessment for prospective permanent carers
- Form 12c - Medical assessment for prospective permanent carers - release of personal information
- Form 12d - GP report to the department or community service organisation
- Form 13 - Life story for new applicants
- Form 14 - Reference letter for new applicants
- Form 15 - Letter to childcare, kindergarten or school
- Form 16 - Letter to applicant to advise of receipt of documents
- Form 17 - Consent to provide assessment report
- Form 18 - Permanent care applicant assessment committee
- Form 19 - Child matching discussion form
- Form 20 - Applicant approval letter
- Form 21 - Undertaking to advise change of circumstances
- Form 22 - Renewal of approval letter
- Form 23 - Letter to carers at commencement of permanent care placement
- Form 24 - Consent to safety screening check by permanent care applicants
- Form 25 - Consent to safety screening checks by household members
- Form 26 - Permanent care approved applicant referral to the Central Resource Exchange
- Form 27 - Statutory declaration in lieu of international police check
- Form 28 - Statutory declaration for international police check
Police history checks
- National police history check request form - child protection
- Authorised delegates signature form
- Consent to check and release national police record
Referrals
- Take Two harm consequences assessment
- Letter of referral for service
- Generic referral form (applicable to all program areas)
Staff supervision
- Case supervision and decision record (template)
- CPP3 - CPP6 Supervision agreement (template)
- Reference Card and checklist for supervisors (template/reference card)
- Reflective case supervision tool (fillable/printable and tear off pads)
- Self-care and wellbeing plan (template)
- Supervision in Child Protection practice - Operational practice guide
- Supervision record with embedded agenda (template)
Therapeutic treatment orders
Therapeutic treatment orders link
- Form 4 Application for therapeutic treatment order
- Form 6 Application for therapeutic treatment (placement) order
- From 8 Application to vary or revoke therapeutic treatment order of therapeutic treatment (placement) order ss.257 & 258
- Form 9 Application for extension of therapeutic treatment order of therapeutic treatment (placement) order s. 255
- Form 15A Application to vary an Interim Accommodation Order or for a new Order (therapeutic treatment order application) s.262
- TTO court report
- TTO extension court report
- TTO revoke court report
- Therapeutic Treatment Board referral
- Report to criminal division on outcome of TTO s.353
- Letter to criminal division re extension of a TTO
- Letter to criminal division re revocation
- Letter to magistrate re application outcome
- Letter to magistrate for no TTO s.350
- Letter to magistrate advising application for TTO s.350
- Referral to the TTB with recommendation to revoke
- TTB meeting dates 2024