Information That May Be Helpful When Making a
Referral to Alberta Children and Youth Services
This checklist is a reference tool to assist when making a referral to Alberta Children and Youth Services. These are some of the questions that may be asked by the Intake Caseworker when taking the report. The referral source may not be able to provide all the information being requested because they do not have the information.
□ Current reason(s) suggesting the need for child intervention (why the referral is being made, the incident that prompted the referral)
□ The present condition of the child(ren) - Is the child injured, alone, or in potential immediate danger?
□ Is the child at risk of further harm?
□ Identifying information of the child(ren)/youth (name, sex, date of birth, Aboriginal/Métis, address, current whereabouts (school, daycare, home), where they attend school
□ Identifying information (name, sex, date of birth, Aboriginal/Métis, address, current whereabouts, where they attend school) of any other children who may be in the home and may also be in need of intervention
□ Identifying information of the guardian(s) (name, date of birth, Aboriginal/Métis, address, place of employment)
□ As much identifying information on all persons involved
□ Whether the family is aware of the referral
□ The referral sources relationship to the child(ren)/family
□ How long has the referral source known the child(ren)/family
□ The name, address and telephone number of the referral source (all reports are confidential, however, you may choose to remain anonymous)
□ Any risk factors to a caseworker who may respond to the situation (e.g. weapons, drugs, animals)
□ What has the referral source seen/heard
□ What has the child or others told the referral source
Checklist provided by: Government of Alberta Children & Youth Services, www.child.alberta.ca, June 2010
