Home Visit Checklist

How to access the information on this page:

  1. 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

Observable injuries

Physical/dental concerns

Clean & dressed

Clothes & shoes fit

Positive/negative changes

Caregiver/Child Interactions

Caregiver identified

General condition/demeanor of caregiver

Caregiver positive/negative statements about child’s development/personality

Adequate supervision

Infant held appropriately

Caregiver maintains eye contact with child

Caregiver’s intonation with child

Good physical contact (i.e., cuddling, hugging, etc.)

Caregiver’s response to child’s cries, requests, demands

Note types of discipline

Note types of activities

Diaper change?


Positive/negative changes


Home is clean & maintained

Lighting in home is appropriate

Furniture concerns?

Physical hazards?

Running water/working plumbing?

Rodent or bug infestation

Child’s sleeping arrangement is safe & secure

Books & toys observed

If animals are present, is child safe?

Positive/negative changes: