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The Reporter should notify the CPC using this template within one working day of identifying a potential significant case for review. The Reporter should also use this same template to notify all other agencies known to be involved. These involved agencies should in turn use this same template to submit their own reports to the CPC within 10 working days.
ANNEX 2: INITIAL CASE REVIEW REPORT
Name of Agency notifying potential Significant Case for Review
Child's Name/Identifier:
Date of Birth:
Name of Parents/Carers: |
Brief description of incident and basis for referral: |
Key facts/background to the case: |
Agency/professional involved: |
Summary of findings of the initial case review: |
Any other statutory proceedings underway: |
Lead contacts for each agency: |
Date issued to Agency:
Person completing this form:
Date returned to Chair of CPC:
Copy to be retained in Child's record
Copy to Executive Lead for Agency
Copy to Senior Local person in agency
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