MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION Critical Event Case Review
Attach a copy of the CS-23 for the critical event being reviewed
If this is a resource home, complete the CD-164 RF in lieu of this form.
Name of Child	Reviewer
Case Family Name	Critical Event Circuit/County
Current Incident Number	Date Review Completed
Current Incident Date	Foster Care Case Management Agency
Summary of Critical Event (please include the most recent information available):
Family Functioning (strengths, challenges, relationship dynamics, recent changes to household composition)
Household Composition: (name, DOB, role)
Answer each of the following questions for the Current Critical Event:
Date of last worker contact with each household child following the critical event (If no contact, please explain.)
How was safety ensured following the critical event?
If applicable, is communication with members of the Family Support Team regarding the critical event documented in the record? Please explain.
Additional Reviewer Comments