Cants 5 Form PDF Details

In the realm of child welfare and protection, few documents bear as much significance as the CANTS 5 form, a critical piece utilized by the Illinois Department of Children and Family Services. This document, designed as a written confirmation of suspected child abuse or neglect, serves as a pivotal communication tool for mandated reporters. These reporters, bound by the Abused and Neglected Child Reporting Act (325 ILCS 5 et seq), must promptly communicate any suspicions or evidence of maltreatment towards children. The CANTS 5 form not only facilitates this legal obligation by structuring the reporter's observations, evidences, and interactions related to the abuse or neglect but also underscores the state's commitment to safeguarding its youngest citizens. By requiring a description of the injuries or signs of maltreatment, details on how and when the abuse occurred, and any previous evidence of harm, the form ensures a thorough account is recorded. Additionally, it captures the reporter's relationship to the child, actions recommended or taken, and their willingness to inform the child's family about the concerns raised, all of which are crucial for the ensuing investigation and interventions. Further reinforced by detailed instructions for submission, including the urgency of a follow-up written report after an initial oral alert via telephone, the CANTS 5 underscores a comprehensive approach to child protection within Illinois. Overall, this document stands as a testament to the procedural and moral rigor applied in confronting and curtailing child abuse and neglect.

QuestionAnswer
Form NameCants 5 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdcfs cant 5 form, cants 5, cants5, cant 5 form

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CANTS 5

State of Illinois

Rev. 10/00

Department of Children and Family Services

 

 

WRITTEN CONFIRMATION OF SUSPECTED CHILD ABUSE/NEGLECT REPORT:

 

 

MANDATED REPORTERS

 

 

 

 

DATE:

ABOUT:

 

 

 

 

Child’s Name

 

 

Child’s Birth Date

If you are reporting more than one child from the same family please list their names and birth date in the space provided on the reverse side of this form.

Street Address

City

Zip Code

Parent/Custodians:

Name

Address (if different than the child’s address)

This is to confirm my oral report of,, made in accordance with the

Abused and Neglected Child reporting Act (325 ILCS 5 et seq). Please answer the following questions. (If you need more space, use the back of this page.)

1.What injuries or signs of abuse/neglect are there?

2.How and approximately when did the abuse/neglect occur and how did you become aware of the abuse/neglect?

3. Had there been evidence of abuse/neglect before now?

Yes

No

4.If the answer to question 3 is “yes,” please explain the nature of the abuse/neglect.

5.Names and addresses of other persons who may be willing to provide information about this case.

6.Your relationship to child(ren)

7.Reporter Action Recommended or Taken:

PLEASE CHECK THE APPROPRIATE RESPONSE:

I saw the child(ren)

 

 

 

 

I heard about the child(ren)

From whom?

 

I

have

have not told the child’s family of my concern and of my report to the Department.

I am

willing

NOT willing to tell the child’s family of my concern and of my report to the Department.

I

believe

 

do NOT believe the child is in immediate physical danger.

 

 

 

 

 

 

 

 

 

 

 

(Name Printed)

 

 

 

(Signature)

 

 

 

 

 

 

 

 

 

 

 

(Title)

 

 

 

(Organization/Agency)

INSTRUCTIONS ON REVERSE SIDE

INSTRUCTIONS

The Abused and Neglected Child Reporting Act states that mandated reporters shall promptly report or cause reports to be made in accordance with the provisions of the ACT.

The report should be made immediately by telephone to the IDCFS Child Abuse Hotline (800-252-2873) and confirmed in writing via the U.S. Mail, postage prepaid, within 48 hours of the initial report.

MAILING INSTRUCTIONS

Mail the original to the nearest office of the Illinois Department of Children and Family Services, Attention: Child Protective Services.

2nd Child’s Name (If Any)

3rd Child’s Name (If Any)

2nd Child’s Birth Date

3rd Child’s Birth Date

DCFS is an equal opportunity employer, and prohibits unlawful discrimination in all of its programs and/or services.

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Make sure you provide the following details to prepare the cants 5 form PDF:

dcfs cant form gaps to fill in

Complete the How and approximately when did, Had there been evidence of, Yes, If the answer to question is yes, Names and addresses of other, Your relationship to children, Reporter Action Recommended or, PLEASE CHECK THE APPROPRIATE, I saw the children I heard about, From whom, have, have not told the childs family of, and I I am I section using the particulars requested by the program.

Finishing dcfs cant form part 2

Note the vital information in have, have not told the childs family of, willing, NOT willing to tell the childs, I I am I, believe, do NOT believe the child is in, Name Printed, Title, Signature, OrganizationAgency, and INSTRUCTIONS ON REVERSE SIDE segment.

step 3 to entering details in dcfs cant form

The nd Childs Name If Any, nd Childs Birth Date, rd Childs Name If Any, and rd Childs Birth Date field could be used to specify the rights and responsibilities of each party.

part 4 to filling out dcfs cant form

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