In the world of child welfare and group home management, maintaining a well-organized and compliant personnel record is not just important—it's essential for ensuring the safety and well-being of children in care. The Dcf F Cfs0383 form, a creation of the Department of Children and Families (DCF) Division of Safety and Permanence, serves as a cornerstone for achieving this goal. Although filling out this form is technically voluntary, its role as a review document is invaluable for group homes striving to meet the compliance standards set forth in DCF 57.16, 57.17(2), 57.17(3), and 57.37(4). Licensing specialists often utilize this form during monitoring visits to verify that group homes adhere to these critical rules. The form meticulously lists the necessary information and documentation that must be kept on file for each employee, including but not limited to personal details, employment start dates, job titles, training, education, work experience, and various checks and certifications such as caregiver background checks, physical examinations, CPR and first aid certifications, and tuberculosis test results. It significantly notes exemptions for relief help and volunteers, specifying which documents are not required for their files. Everything from orientation documentation to disciplinary actions and authorization to administer medication is covered, making the Dcf F Cfs0383 form an all-encompassing tool for ensuring personnel records are comprehensive and up-to-date. This attention to detail helps group homes not only comply with licensing rules but also enhances the overall safety and quality of care provided to children.
| Question | Answer |
|---|---|
| Form Name | Form Dcf F Cfs0383 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | dcf_f_cfs0383 checklist group home nj compliance form |
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Safety and Permanence
Personnel Record Checklist – Group Homes
Use of form: Use of this form is voluntary. However, use as a review document by group homes will help ensure compliance with DCF 57.16, 57.17(2), 57.17(3) and 57.37(4). Licensing specialists may also use this form during monitoring visits to document compliance with these rules. Personally identifiable information gathered on this form will be used only to verify compliance with licensing rules.
Instructions: A check mark indicates the required information is in the file. The name, start date and job title must be entered. If additional space is needed, attach separate sheet(s).
Relief help: The personnel record for relief help does not need to contain the physical examination or HealthCheck form. Volunteers: The personnel record for volunteers does not need to contain the physical examination or HealthCheck form, the background check results from the Department of Justice (DOJ), the Department of Health Services (DHS) Response to Caregiver Background Check (IBIS), (the
Name – Group Home
Facility ID Number
Address – Group Home (Street, City, Zip Code)
Telephone Number – Group Home
Name
Name
Name
Name
Completed Application Form 57.17(2)(a)
Job title
Date of hire
Address
Birthdate
Training
Education
Work experience
Current address 57.17(2)(b)
Addresses and telephone numbers of references and reference check results 57.17(2)(c)
Caregiver Background Check
DOJ results 57.17(2)(e)
Response to Caregiver Background Check (IBIS) 57.17(2)(e)
Results of any subsequent investigation related to information obtained from each CBC 57.17(2)(e)
A completed physical examination or HealthCheck form 57.17(2)(g)
Tuberculosis test results 57.17(2)(g)
The staff member’s annual driver’s record, if the staff member is assigned to transport children 57.17(2)(h)
|
Training Record |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Document of orientation 57.17(2)(i) |
|
|
|
|
|
|
|
|
|
|
|
|
|
||
A job description that is signed and dated by the staff member 57.17(2)(f) |
|
|
|
|
|
||
|
|
|
|
|
|
||
Documentation of all first aid certifications 57.17(2)(j) |
|
|
|
|
|
||
|
|
|
|
|
|
|
|
Documentation of all CPR certifications |
57.17(2)(j) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Automatic external defibrillator training |
57.14(4m) |
|
|
|
|
|
|
|
|
|
|
|
|
||
Documentation of fire safety and evacuation training 57.16(3) |
|
|
|
|
|
||
|
|
|
|
|
|
||
Documentation of continuing education (at least 24 hours annually) 57.16(5) |
|
|
|
|
|
||
|
|
|
|
|
|
||
Documentation of infant and toddler training if applicable 57.37(4) |
|
|
|
|
|
||
|
|
|
|
|
|
||
Any disciplinary actions issued to the employee 57.17(2)(k) |
|
|
|
|
|
||
|
|
|
|
|
|
||
Written authorization to administer medication to residents 57.25(2)(b) |
|
|
|
|
|
||
|
|
|
|
|
|
|
|
SIGNATURE – Licensing Specialist |
|
|
|
Date Signed |
|
|
|
|
|
|
|
|
|
|
|
2