Petition and Notice of Further Hearing (CFS-20)
An agency uses this form when a child has an Order for Temporary Guardianship and  is still in need of protection requesting that another Order be made.This is a statutory regulated form embedded in The Child and Family Services Regulation
Department/Crown:Families
Category:Families
Petition and Notice of Hearing (CFS-18)
The agency believes that  a was, and is still, subjected to abuse. They are petitioning the court to receive guardianship of the child. This is a statutory regulated form embedded in The Child and Family Services Regulation
Department/Crown:Families
Category:Families
Place of Safety Placement
This form is used to identify the children, dates of birth and their locations when apprehended and taken to a place of safety. It is an agency form and should be filled out by the caseworker.
Department/Crown:Families
Category:Families
Placement Referral Report
This form is used when referring a child in care from one placement to another. It is filled out by the caseworker and contains information on the child and the reason for the referral. This is an internal record and is kept in the CIC file.
Department/Crown:Families
Category:Families
Prior Learning Assessment Program Participant Manual

The Prior Learning Assessment (PLA) Program is for child care assistants (CCAs) with post-secondary credentials from foreign countries or from programs which are not accredited by the Child Care Qualifications and Training Committee. These CCAs also have substantial experience working with children and families.

This manual is a resource for the participant, as well as the assessment team. It provides information about the program and identifies the requirements and expectations of the program.

Department/Crown:Education and Early Childhood Learning
Categories:Accreditation, Certification, Education and Training, Families
Provincial Investigations (PI)Unit - Referral Form
This form must be completed in full in order to meet the requirement of notifying the Director of Child and Family Services of abuse allegations, per The Child and Family Services Act, Section 18(6) " Where an agency receives information that a child was or might have been abused by a person who provides work for or services to the agency or to a child care facility or other place where a child has been placed by the agency, the agency shall, in addition to carrying out its duties under subsection 18.4(1) and section 18.5, immediately report the matter to the director and the director shall investigate the matter and take such further steps as are required by this Act, prescribed by regulation, or as the director considers necessary.  This is an internal form that is filled out by agencies when reported abuse allegations.
Department/Crown:Families
Categories:Families, Youth
Referral to Independent Living Program
When a youth is leaving the Child and Family Services System because they are approaching their 18th birthday, their caseworker must (if applicable) make a referral to independent living programs. The caseworker uses their agency form to make that referral. 
Department/Crown:Families
Categories:Application, Families
Registered Pension Plans and Retirement Supports
This document outlines types of funding support available to child care workers to help them plan for their retirement. Information is provided about eligibility and options for registered pension plans for full-and part-time child care workers, the matched registered retirement savings plan contributions and the long-term service recognition retirement benefit.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Employment, Families
Registration by Adopted Adult
Registration by Adopted Adult for Adoptions Finalized in Manitoba form: An adoptee can fill out this form to request a search for information on their birth family. If a disclosure veto has not been received, the Manitoba Post-Adoption unit will provide information to the adoptee.
Department/Crown:Families
Categories:Application, Families
Renewal of Family Support Agreement (CFS-6)
Under the Child and Family Services Act, Subsection 15(2) Financial information and maintenance agreement the agency shall request the parent or guardian to agrees to pay to the agency maintenance for the child in accordance with the regulations . This is the renewal form and must not  be changed other than by an amendment to the regulation. This is an agency form and is filled out by a case worker.
Department/Crown:Families
Category:Families
Renewal of Voluntary Placement Agreement
A voluntary placement agreement may not last more than 12 months and may be renewed to a maximum of 24 months. This is a statutory regulated form embedded in The Child and Family Services Regulation
Department/Crown:Families
Category:Families
Report to the Adult Abuse Registry Committee - Designated Officer
Not for Public Use. Application pursuant to Subsection 41(2) of The Adult Abuse Registry Act for access to the Adult Abuse Registry by a designated officer. Designated officer means an executive director appointed under The Vulnerable Persons Living with a Mental Disability Act, or a person specified with respect to any other designated Act (as defined in The Adult Abuse Registry Act).  
Department/Crown:Families
Category:Families
Report to the Child Abuse Registry - Peace Officer
Not for Public Use.  This form is for a Peace Officer to provide the name of the person and the details of the offence to the Provincial Child Abuse Registry.  Where a person was found guilty, pleaded guilty to an offence involving the abuse of a child in a court in, or outside of Manitoba, the name of that person, the circumstances of the abuse and any sentence imposed must be reported for entry on the Child Abuse Registry.
Department/Crown:Families
Category:Families
Request for Adoptive Family Profile
This is a request by a member of the birth family to receive all available non-identifying background information regarding the adoptee's adoptive family, as well as the adoptee's well-being at the time of birth and adoption.
Category:Families
Request for Birth Family History

The Request for Birth Family History by Adult Child of a Deceased Adoptee form allows the adult child of a deceased adoptee to receive all available non-identifying background information regarding the adoptee's birth family. 

Category:Families
Requirements for Licensed Child Care Centres
This document summarizes the areas of compliance to be met (health, fire, zoning and building regulations) as well as child care licensing requirements, when constructing and/or renovating a space for use as a child care centre in Manitoba.
Department/Crown:Families
Categories:Families, Licence
Residential Care Licensing - Adult Abuse Registry Record Statement
This form is completed by service providers of home shares (including agency supported home shares), mental health facilities, and facilities providing care for persons requiring support due to frailty or cognitive impairment related to aging during the annual review or renewal process.  By completing the form, the service provider declares whether, to the best of their knowledge, they as the service provider, any other persons providing residential care in the facility or any other adult (other than residents) residing in the facility, has been placed on the Adult Abuse Registry or is presently under investigation for an allegation of abuse or neglect.
Department/Crown:Families
Category:Families
Residential Care Licensing - Authorization for Self-Administration of Medication
This form, completed by a residential care facility resident's attending physician and supervising agency, authorizes residential care facility operators or staff employed by operators or agencies to allow the resident to self-administer medications as directed by the physician, provided that the facility maintains an appropriate level of drug security to prevent unauthorized access and risks to others.
Department/Crown:Families
Category:Families
Residential Care Licensing - Careprovider Homestudy
This form is completed by Residential Care Licensing staff as part of the application process for individuals who are interested in becoming a licensed care provider for the Community Living disABILITY Services program.  It provides information about the prospective care provider, such as their motivation to provide care, their personality, interests, and health, as well as information about their home, including its physical structure, other residents (if applicable), and sleeping accommodations.
Department/Crown:Families
Category:Families
Residential Care Licensing - Criminal Records Statement
This form is completed by service providers of home shares (including agency supported home shares), mental health facilities, and facilities providing care for persons requiring support due to frailty or cognitive impairment related to aging during the annual review or renewal process.  By completing the form, the service provider declares whether, to the best of their knowledge, they as the service provider, any other persons providing residential care in the facility or any other adult (other than residents) residing in the facility, has been charged with or investigated for any criminal or illegal activities.
Department/Crown:Families
Category:Families
Residential Care Licensing - Dental Record
This dental record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Fire Drill Log Form
This form is completed by residential care facility operators or staff employed by operators or agencies on a monthly basis to record fire drills conducted at residential care facilities, including the date and time of drills, evacuation times, exits used, participant information, problems encountered, and actions taken.
Department/Crown:Families
Category:Families
Residential Care Licensing - Life Safety Initiative - Certificate of Completion
This form is completed by the registered owner(s) of a residential care facility and the contractor(s) responsible for installing approved life safety equipment at the facility after the installation is complete.  By completing the form, the registered owner(s) acknowledge that the work has been completed to their satisfaction, that the equipment is ready for use, and that the Department of Families is not responsible for the ongoing maintenance or removal of the equipment, while the contractor certifies that the equipment meets all municipal and provincial by-laws with respect to installation, safety and operation.
Department/Crown:Families
Category:Families
Residential Care Licensing - Life Safety Initiative - Confirmation of Approval Letter
This letter, sent from the Department of Families to agencies or residential care facility operators who have successfully submitted three written quotes for the installation of required life safety equipment to the department for review, informs the agency or residential care facility operator that the department has approved Life Safety Initiative funding for the installation of the required equipment at the facility.
Department/Crown:Families
Category:Families
Residential Care Licensing - Life Safety Initiative - Invitation Letter
This letter, sent from the Department of Families to agencies or residential care facility operators who have applied for funding through the Life Safety Initiative (LSI), informs the agency or operator that they have met the necessary requirements for LSI funding, and invites them to obtain three written quotes for the installation of the required  equipment at the facility and submit them to the department for review.
Department/Crown:Families
Category:Families
Residential Care Licensing - Medical Record
This medical record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Optical Record
This optical record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Physical Structure Report Form
This form, completed by individuals who are interested in becoming a licensed or approved residential care facility operator as part of the application process, verifies the physical structure of the facility, including the number of rooms, number of storeys, heating, water and sewage, and bedroom dimensions. 
Department/Crown:Families
Category:Families
Residential Care Licensing - PRN Medication
This form is completed by residential care facility operators or staff employed by operators or agencies for each resident who takes PRN (i.e., as required) medications ordered by a physician.   The facility must maintain the form on each resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Resident's Personal File Face Sheet
This form, completed and maintained by residential care facility operators or staff employed by operators or agencies, is kept on each residential care facility resident's personal file.  The form records information about the resident such as identifying information, medical contacts, financial information, and critical information.
Department/Crown:Families
Category:Families
Residential Care Licensing - Revisions to Menu
This form, completed by residential care facility operators or staff employed by operators or agencies in facilities with more than eight residents and kept on file for a period of at least three months, records necessary variations to the facility's weekly menu.
Department/Crown:Families
Category:Families
Residential Care Licensing - Risk Assessment Policy
This policy outlines the process for conducting Residential Care Occupancy Risk Assessments in shift-staffed residential care facilities operating under a letter of approval.  The policy also applies to host family homes (i.e., home shares) as best practice.
Department/Crown:Families
Category:Families
Residential Care Licensing - Staff Orientation Format
This orientation checklist is completed by residential care facility operators or staff employed by operators or agencies.  Residential Care Licensing requires operators to provide each employee with an orientation to residential care standards, policies, procedures, and routines using this form (or form in a similar format).  The operator must retain the form on each individual's personnel file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Weekly Menu
This form, completed by residential care facility operators or staff employed by operators or agencies in facilities with more than eight residents and kept on file for a period of at least three months, is the weekly menu plan for the facility.
Department/Crown:Families
Category:Families
Respite in the Community - Guide for Parents
This document provides information to parents and guardians of children open to Children's disABILITY Services about when their child goes on an outing with a department-managed respite provider. This guide includes an activity plan that requests input from families to help plan outings.
Department/Crown:Families
Categories:Application, Families
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