Foster Home Safety Checklist Template


Home: ___________________________
Date: __________________
Social Worker: ____________________________
Check One:
_____ Telephone service connected, phones working properly, easily & accessible.
Emergency numbers are posted within view of phone.
_____ Well water clearance must be obtained if water is from a private source.
_____ House appears reasonably neat and clutter free.
_____ Windows have screens in good repair.
_____ Windows have curtains or shades to provide privacy.
_____ Windows are intact and open windows can be closed without difficulty.
_____ Carpets are clean and in good repair.
_____ Floors are clean and in good repair.
_____ Ceilings, corners, closets, and window frames are free of dirt and cobwebs.
_____ Electrical switches and receptacles are in good working order.
_____ Type of heating, ________________________, is in good working order, well
vented, and able to be turned off.
_____ Heating capable of heating entire house to comfort. If not, what are
alternative modes of heating? ___________________________________
_____ Air Conditioning system is operable and in good working order.
_____ Hot water source is large enough for household needs and area around it is clean.
_____ Fireplaces, wood stoves and open faced heaters shall be made inaccessible to
children by the use of screens or other barriers.
_____ Hot water is between 105 and 120 degrees at the faucets.
_____ Smoke detectors are working, properly placed, and batteries are checked regularly
(every 3 months). A working smoke detector must be present in each bedroom.
_____ Hallways and bedrooms have clear passages, and all rooms including hallways,
passages, and outside doorways and walkways have adequate lighting.


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