Form Rfa-04 - Resource Family Risk Assessment Page 2
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2STATE OF CAIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
RESOURCE FAMILY APPROVAL
RESOURCE FAMILY RISK ASSESSMENT
Summary of Risk Assessment
The following evaluation(s) are necessary for completion of the Resource Family Assessment Process.
Based upon an assessmemt of the information obtained, there are no presenting risk factors at the
time of assessment.
SOCIAL WORKER SIGNATURE:
MONTH/DAY/YEAR
SUPERVISOR SIGNATURE:
MONTH/DAY/YEAR
RFA-04 (11/13)
RESOURCE FAMILY RISK ASSESSMENT
PAGE 2 OF 2
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