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Social Worker Home Visit Template

A home visits checklist for social work is necessary because it allows a social worker to gather all of the information they need in one place, so nothing is left out. This will help ensure that the client gets the best service possible. Preparing for home visits can seem overwhelming, but it doesn't have to be.

You can read our guide article to use this template to its maximum effectiveness. In addition, we recommend that you browse through the hundreds of templates we offer to facilitate your work in the simplest and most innovative way. With a good strategy and the right methodology, you can save costs, time and ensure maximum efficiency.

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Social Worker Home Visit Template


Facility is clean, sanitary, and free of hazards including window blind cord hazards

Adequate handrails and raps provided

Operating emergency lighting available

Age appropriate furnishing and activities for children under care

Bathroom, kitchen floors are washable

Premises are free from pests

Address is clearly visible and location accessible

Supervision plan is in place if hazardous condition exist

Pools are adequately fenced to discourage climbing

A supervision plan is in place when the home has a pool or bodies of water

Pets and animals are safe and free from disease

Alcoholic beverages are inaccessible

Smoking is prohibited in all living spaces and in car with children

Guns and other weapons are secure and inaccessible to children. Describe weapons and location

Ammunition is inaccessible and separate from weapons if not in a gun safe

Cleaning supplies, toxic substances, etc. are inaccessible

Family has plan for obtaining car seats for age range as needed

Wheeled baby walkers will not be used

Home has at least one working telephone for emergencies

Light fixtures provide children good visibility and comfort

Room temperatures at reasonable levels

Home has adequate ventilation

Home has adequate laundry facilities and storage

Laundry contaminated with urine, feces, or other potentially infectious materials is adequately sanitized

Toilet and bathing facilities allow privacy for child 5 years and older

Bathing facilities have grab bars or non-skid pads

Water is from public system or approved private supply

Sewage and waste is discharged into a public system or septic

Safety/sanitary requirements are followed for diapers, diaper changing and toiler training equipment

Fire Safety

Locks on outside exit doors unlock when knob is turned from inside

Home has one swinging exit door that is hinged or pivoted on the side

Home has two exits

Every occupied area has access to at leats one xit

Obstacles are not placed in exit ways, stairways, or rescue windows

Any barrier to exiting is easily opened and does not cause delay

Stoves, heaters or obstacles do not block exit ways

Flammable material and poisons are inaccessible to children

Bedroom windows for children in care are large enough for emergency rescue

Fire places, wood stoves, heating systems, have barriers for under age 6

Smoke alarms are in good working condition and are mounted correctly

Home has at least one working 2A10BC-rated 5lb. or larger ABc fire extinguisher

Multi-level homes must have escape from upper floor

Family has a written fire evacuation plan for the home


Bedrooms have adequate ceiling height

Bedrooms have unrestricted direct access to common rooms

Children 6 years and older do not share bedroom with opposite gender

Room has adequate floor space for safety and comfort

Child 1 year and older does not share parent's bedroom unless recommends

No more than 4 children per bedrom

80 square feet if mother and newborn per bedroom

Only one mother and newborn per pedroom

Each child has at least a 27 inch wide clean, comfortable bed of their own

All beds and cribs used for sleeping have waterproof mattress materials if needed

Toddler beds have standard crib mattress sufficient in length and width for the comfort of the child under age 6

Crib meets all safety requirements

Crib must have no more than 2 3/8 inches between slats

Crib bumpers, stuffed toys, pillows not placed in cribs with infants

Infants are placed on their backs for sleeping

Upper bunks not used by anyone who might be endagered

Medical Care and Medications

First aid supplies are on hand

Poison control number with first aid supplies and posted or near telephone

All medications are in locked storage with pet medications separate from human medications and external medications separate from internal

Parents have proof of currents immunizations' children or exemption in file

Prescription medications given to foster children recorded

Medications are given only according to prescription labels

(check name not set)


Food served to children and infants meets needs of the children


TB test completed for all caregivers/licensees; other adults in the home over age 18 including foster parent's own teens turning 18

Applicants are at least 21 years of age

Attended Orientation an Pre-Service


Applicant/Provider Name

Inspection Date

Qualifications/Training (Continued)

All caregivers have First Aid/CPR: training expires


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

Age of the children:

All caregivers have HIV/AIDS training


Applicant's Signature

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