Form Jfs 01348 - Safety Audit Of A Foster Home
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Ohio Department of Job and Family Services
SAFETY AUDIT OF A FOSTER HOME
Also used for adoptive homes
Identifying Information:
Name of Caregiver #1 (Last)
First
Name of Caregiver #2 (Last)
First
Street Address
City
State
Zip Code
Name of Agency
Initial Certification
Recertification
Adoptive Home
Relocation
The home and all structures associated with the home are maintained in a clean, safe, and sanitary
1.
Yes
No
condition and in a reasonable state of repair. 5101:2-7-12(A)
Outdoor recreation equipment on the grounds of the home is maintained in a safe state of repair.
2.
Yes
No
N/A
5101:2-7-12(B)
Potentially hazardous outdoor areas on the grounds of or immediately adjacent to the home are
3.
No
N/A
Yes
reasonably safeguarded. 5101:2-7-12(C)
Yes
No
4.
The home is adequately heated, lighted and ventilated. 5101:2-7-12(D)
Bleach, cleaning materials, other poisonous or corrosive household chemicals, flammable and
5.
Yes
No
combustible materials, potentially dangerous tools or utensils, and electrical equipment or machinery
in or on the grounds of the home are stored in a safe manner. 5101:2-7-12(E)
Firearm, air rifles, hunting slingshot or other projectile weapons kept on the grounds of or in the home
6.
No
N/A
Yes
are stored in an inoperative condition in a locked area inaccessible to children. 5101:2-7-12(F)
Ammunition, arrows or projectiles for weapons are stored in a locked area separate from the weapon.
7.
Yes
No
N/A
5101:2-7-12(F)
Yes
No
8.
There is reasonable access to a working telephone for emergency situations. 5101:2-7-12 (G)
Emergency telephone numbers posted: 5101:2-7-12(H)
9.
Yes
No
Fire
Police
Squad/Rescue
Poison Control
Recommending Agency
Placing Agency
All locking doors to any room or storage area inside the home in which a person could become
10.
Yes
No
confined, and from which the only other means of exit requires the use of a key, shall be able to be
unlocked from either side. 5101:2-7-12(I)
Well water used for drinking and cooking shall be tested and approved by the health department prior
11.
Yes
No
to initial certification of the home and annually; or there is a continuous supply of safe drinking water.
510 1:2-7-12(J)
The home has working bathroom and toilet facilities located within the home and connected to an
12.
Yes
No
indoor plumbing system. 5101:2-7-12(K)
Garbage shall be disposed of on a regular basis. Garbage stored outside shall be in covered
13.
Yes
No
containers or closed bags. 5101:2-7-12(L)
The home has a working smoke alarm approved by "Underwriter's Laboratory" on each level of
14.
Yes
No
occupancy. 5101:2-7-12(M)
The home has a written evacuation plan for evacuating the home or seeking shelter in the event of
15.
Yes
No
fire, tornado or other disaster. 5101:2-7-12(N)
Yes
No
16.
The evacuation plan contains a primary and alternate escape for each floor.
5101:2-7-12(N)
Yes
No
17.
All escape routes shall be kept free of clutter and other obstructions.
5101:2-7-12(O)
JFS 01348 (Rev. 1/2003)
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