How to access the information on this page:
- Directly on this page
2. Home Visit Checklist as a hard copy
3. Home Visit Checklist to download and fill out on your device, making updates anytime
Upon Arrival, please note:
Location of child:
Child’s activity:
Family composition:
Child’s daily routine/sleep schedule:
Child’s Physical Appearance |
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Observable injuries
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Physical/dental concerns
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Clean & dressed
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Clothes & shoes fit
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Positive/negative changes
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Caregiver/Child Interactions |
Caregiver identified
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General condition/demeanor of caregiver
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Caregiver positive/negative statements about child’s development/personality
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Adequate supervision
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Infant held appropriately
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Caregiver maintains eye contact with child
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Caregiver’s intonation with child
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Good physical contact (i.e., cuddling, hugging, etc.)
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Caregiver’s response to child’s cries, requests, demands
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Note types of discipline
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Note types of activities
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Diaper change?
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Feeding?
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Positive/negative changes
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Home |
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Home is clean & maintained
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Lighting in home is appropriate
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Furniture concerns?
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Physical hazards?
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Running water/working plumbing?
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Rodent or bug infestation
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Child’s sleeping arrangement is safe & secure
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Books & toys observed
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If animals are present, is child safe?
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Positive/negative changes:
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