Child 2 name and age: Pre-assessment of carer Program requirement Criterion Carer 1 Carer 2 3.2.5 Disqualified carer check prior to proceeding with assessment of applicant Yes No Date: Yes No Date: New police record check upon application to the CSO Yes No Expiry date: Yes No Expiry date: Three-year renewal completed Yes No NA Expiry date: Yes No NA Expiry date: Disclosable offence Yes No Number: Yes No Number: Written sign-off from the department to proceed Yes No NA Date: Yes No NA Date: Police record checks for household members aged 18 years or older who live or regularly stay overnight Yes No NA Expiry date: Expiry date: Expiry date: Yes No NA Expiry date: Expiry date: Expiry date: International police record check International checks for carer and household members 18 years or older Yes No NA Date: Date: Date: Yes No NA Date: Date: Date: ‘Volunteer (V)’ Working with Children Check An up-to-date WWCC for the carer and any adult member of the household who will have a parenting role with the child Yes No NA Expiry date: Expiry date: Expiry date: Yes No NA Expiry date: Expiry date: Expiry date:
3.2.2/3.2.4 Step by Step Victorian assessment conducted by a qualified SxSV assessor Yes No Date of accreditation: Yes No Date of accreditation: 3.2.5 Reference checks × 3 Yes No Yes No 3.3.1, 3.3.2, 3.3.4, 3.3.5 Pre-service training has been completed prior to panel accreditation: [Empty cell] [Empty cell] Shared Stories Shared Lives Victoria (SSSLV) fully completed by applicant and any others required Yes No Date: Yes No Date: SSSLV was delivered by a qualified SSSLV trainer Yes No Date of accreditation: Yes No Date of accreditation: 3.3.9/3.3.10 Training in culturally appropriate caring, as applicable, ASAP following placement of the child with a non-Aboriginal carer Yes No NA Yes No NA 3.4.4 The approval panel final report (minutes) specify accreditation status for: [Empty cell] [Empty cell] the type of care Yes No Yes No numbers, ages and genders of children Yes No Yes No any special conditions attached to the approval Yes No NA Yes No NA priority training needs identified Yes No NA Yes No NA level and type of support to be provided by the CSO or other organisations Yes No Yes No the review process Yes No Yes No 3.4.5 Foster carer accreditation approved by panel and report (minutes) signed by panel chairperson Yes No Date of carer approval: Yes No Date of carer approval: 3.4.6 The CSO has registered the foster carer on the carer register within 14 days of approval Yes No Date registered by CSO: Yes No Date registered by CSO: 3.4.8 A signed copy of a code of conduct for approved carers Yes No Yes No
2.1.2, 2.1.7, 2.1.11, 2.9 Essential Information Record Yes No NA Overdue Date(s): Yes No NA Overdue Date(s): 2.1.7, 2.1.8, 2.1.9, 2.1.11 Care and Placement Plan Yes No NA Overdue Date(s): Yes No NA Overdue Date(s): 2.1.7, 2.1.8, 2.1.9, 2.1.11, 15+ Care and Transition Plan Yes No NA Overdue Date(s): Yes No NA Overdue Date(s): 2.1.10, 2.1.11 Assessment and Progress Record Yes No NA Overdue Date(s): Yes No NA Overdue Date(s): Client care requirements Program requirement Criterion Client 1 Client 2 1.2.2/1.2.3 Children entering HBC for the first time (or for the first time during the current period of involvement) will have their medical health needs identified by a medical practitioner ASAP or within one month of entering care. Medical Yes No NA Overdue Date(s): Medical Yes No NA Overdue Date(s): Dental Yes No NA Overdue Date(s): Dental Yes No NA Overdue Date(s): If a child is entering from another placement, the CSO confirms the last date on which the child received a health assessment and arranges any assessment that may be required. Optical Yes No NA Overdue Date(s): Optical Yes No NA Overdue Date(s): Auditory Yes No NA Overdue Date(s): Auditory Yes No NA Overdue Date(s): 1.2.4 Annual health check – medical Yes No NA Date(s): Yes No NA Date(s):