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CHILDREN’S ADMINISTRATION

DIVISION OF LICENSED RESOURCES

Foster Home Inspection Checklist

APPLICANT / PROVIDER NAME

TELEPHONE NUMBER

INSPECTION DATE

1475

Children six (6) years and older do not share bedroom with

opposite gender.

80 square feet if parent and his / her infant share bedroom.

Only one parent and infant(s) per bedroom.

No more than four (4) children per bedroom.

Child one (1) year and older does not share bedroom with an

adult that is not the child’s parent unless MD recommends.

Extended foster care youth may not share a bedroom with a

youth younger than 10 years of age; exceptions can be made if

in the best interest of the child.

Immunizations / Medical Care / Medications

Comments / Notes / Corrections

1320

Foster parent’s own children have proof of current immunizations

or exemption in file. These documents are to be viewed by the

licensor and returned to the foster parent, not placed in the file.

Pertussis and influenza immunizations for all household

members if taking placements of children under age two.

1550

First aid supplies are on hand.

1565

All medications are in locked storage with pet medications

separate from human medications and external medications

separate from internal.

1575

Prescription medications given to foster children recorded.

Medications are given only according to prescription labels.

Food / Diet

Comments / Notes / Corrections

1440

Home must meet acceptable health standards for the storage

and preparation of food.

1520

Food served to children and infants meets needs of the children.

Qualifications / Training

Comments / Notes / Corrections

1320

TB test completed for all caregivers / licensees and other adults

in the home over age 18 including foster parent’s own teens

turning 18.

1365

Applicants are at least 21 years of age.

1375

Attended Orientation and Pre-Service: date

All caregivers have First Aid/CPR: training expires

CPR training is appropriate to the age range of children on the

license: training for ages

All caregivers have HIV / AIDS training.

Signatures

APPLICANT’S SIGNATURE

DATE

LICENSOR’S SIGNATURE

DATE

Additional items to discuss with the Foster Parent:

• Adequate handrails and ramps

• Operating emergency lighting available.

• Toilet and bathing facilities allow privacy for child five (5) years and older.

• Toddlers have potty chairs and toilet training equipment.

• Bathing facilities have grab bars or non-skid pads.

Page 3 of 3

DSHS 10-183 (REV. 01/2015)

DISTRIBUTION: File Applicant

Foster Home Inspection Checklist Template - Washington Department Of Social & Health Services Page 3

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