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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

General

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

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/Diet

Food served to children and infants meets needs of the children

Qualifications/Training

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
Date:
Applicant/Provider Name
Inspection Date

Qualifications/Training (Continued)

All caregivers have First Aid/CPR: training expires
Date:
CPR training is appropriate to the age range of children on the license
Age of the children:
All caregivers have HIV/AIDS training

Signatures

Applicant's Signature
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