Foster Care - Provider Home Visit Preparation Checklist Template printable pdf download

Foster Care - Provider Home Visit Preparation Checklist Template

Foster Care – Provider Home Visit

Preparation Checklist

Use this checklist to help you prepare your home for the safety inspection with your licensor.

Directions: Keep one copy for your records and submit a completed copy to the Intake Licensing Specialist

when all items are in compliance. The Intake Licensing Specialist can answer any questions you may have, but

your assigned foster care licensor will give final approval after a physical inspection

1. Working smoke detector on each level (licensor will test)

2. Working carbon monoxide detector on each level

3. 1 fully charged fire extinguisher in home rated 2A:10BC or higher (licensor will check the charge)

4. Locking capability on bathrooms

5. Hazardous areas are mitigated through the use of fences, banisters, railings, grates, natural barriers,

protective hardware or other licensor approved methods:

a. Fall hazards 3 feet or more (steep grades, cliffs, open pits, window wells, stairwells, elevated

porches, retaining walls, etc) are mitigated

b. Drowning hazards (pools, hot tubs, water features, ponds, streams, canals, etc) are mitigated

c. Burn hazards (fireplaces, candles, radiators, etc) are mitigated

d. Unstable heavy items (televisions, bookshelves, etc) are mitigated

e. Dangerous traffic conditions are mitigated

f. Other hazards addressed/mitigated

6. Multi-level homes have: an automatic fire suppression system OR safety escape ladders OR stairway

OR egress to ground level from all upper levels.

7. 911 recognizable phone on site with foster children at all times

8. Emergency contact numbers and address of the home are posted next to the phone or in a central

location

9. Firearms stored with ammo ONLY in a gun safe or commercially manufactured container for firearm

storage

10. Firearms and ammo are locked separately with separate key/combo/locking devices if not stored in

commercially designed firearm storage container

11. Firearms in display cases are rendered inoperable and ammo locked elsewhere

12. Alcohol is inaccessible to foster children

13. Hazardous materials that are required to be locked are: pesticides, bleach, bleach-based cleaners,

compressed air, ammonia and ammonia-based cleaners, chemical drain openers, hair

Apr 2016

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Foster Care - Provider Home Visit Preparation Checklist Template