CP&P 945 (NEW 72004) STATE OF NEW JERSEY DEPARTMENT

CP&P 945 (NEW 72004) STATE OF NEW JERSEY DEPARTMENT
STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA6441 (R072004)



SCR Call Back Message

CP&P 9-45

(new 7/2004)

State of New Jersey

Department of Human Services

Child Protection and Permanency

State Central Registry

Call Back Message


Date Message Taken: Time: ____________ __AM __PM


Caller Name: ______________________________ Title (If applicable):


Agency: __________________________________


_________________________________________


Telephone: (_____) __________________

(Area Code) (Ext.)


Telephone: (_____) ___________________

(Area Code) (Ext.)


Type of Caller:


__ Reporter __ Field Staff __ Other

(Specify)

Type of Call: (if known)


__ CA/N __ CWS __ I&R __ IO __Other

(Specify)

Instructions:


Message Taken By: ________________________ ___________________________

Hotline Worker Name Worker ID #


************************************************************************

Attempts to Return Call

Date: ____________ Time: ________ __AM__ PM ___Successful ___ Unsuccessful


Date: ____________ Time: ________ __AM__ PM ___Successful ___ Unsuccessful

Date: ____________ Time: ________ __AM__ PM ___ Successful___ Unsuccessful

KC#/File Name:

Screener Name:

Screener ID#:


COMMENTS:







Tags: state, 72004), department, jersey