Checklist: Intake Skills*
1.	Used supportive, non-threatening tone of voice.	Yes 	No 	NA  
2.	Treated the caller with respect.	Yes 	No 	NA 
3.	Spoke in a calm and reassuring manner.	Yes 	No 	NA 
4.	Asked clear, concise, precise and explicit questions.	  Yes 	No            NA
5.	Asked questions that elicited a thorough and 
   accurate description of the harmful incident.	    	  Yes           No 		 NA 
6.	Elicited enough information to identify
    and locate parties involved.					  Yes 	No 		NA 
7.	Repeated back to the reporter key information to
ascertain accuracy of recording
(e.g., names, addresses).	Yes 	No                  NA 
8.	Responded honestly to questions 
    that were posed by the reporter.				  Yes 	No 		NA 
9.	Encouraged but did not insist that 
    anonymous reporter disclose his/her identity.		  Yes 	No 		NA 
10.	Ascertained the personal or professional relationship
    between the reporter and the family.	Yes 	No         NA 
11.	Discussed confidentiality of information
(i.e., whether the reporter's identity will
remain confidential or when it might be revealed).	Yes 	No                  NA 
12.	Explained to caller that CPS will look into the situation.   Yes 	No          NA 
13.	1f referral was inappropriate for CPS,
      identified the resources to which the caller could turn.	Yes 	No                  NA 
14.	 Let the caller know that it was right to make the report
      and that the effort is appreciated.	Yes 	No                  NA 
*Reproduced with permission from Creative Associates, Washington, D.C.

CHECKLIST: Information Gathering
The following information was gathered for a report of suspected child abuse or neglect:
_____ Name, age (or birthdate), sex, ethnic background and permanent address of the child(ren)
(victim)    
	
_____ Present location of the  and the location where the suspected child abuse or neglect
occurred
_____ Name of parent, guardian, or custodian (caregivers)
_____ Name and address of the person the reporter believes is responsible for the suspected abuse                 
or neglect (subject)
_____ Family composition (names, sex, ages of siblings and other adults normally present in the
	 (home)         

_____ Nature and extent of the suspected abuse or neglect, including any available information on                                                       prior injury to the child or siblings.
 _____ Any action taken by the reporter

_____	 Reporter's name, telephone number and address
_____  Relationship of the reporter to the child and family
_____  Willingness of the reporter to share with the family his/her role in initiating the report
  or to participate in the assessment process
_____  Motives of the reporter

_____  Names and telephone numbers of additional persons who may have information concerning	   the suspected abuse or neglect

_____  Date and time the report was received