Alabama Evaluation of Unrelated Visitation Resource for Foster Child
In the State of Alabama, evaluating the unrelated visitation resources for a foster child requires the use of this form. The evaluation is also based on the information provided in that form.
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EVA LU ATIO N O F U NRELA TE D V IS IT A TIO N R ESO URC E F O R F O STE R C HIL D DHR-F C S-1 604 A pril, 1 9 90 1 N am e: _ __________________________ County : _ _____________ Case # : _ ____ ______ S pouse : _ _________________________ Tele phone: _______________ H om e ______ ______ W ork A ddre ss: _ ____________________ ________________________ _________________ ______ W ho r e fe rre d fa m ily to D epartm ent a s v is it in g r e so urc e ? _ __________ ______________ ______ N am e(s ) / C ase N um ber(s ) o f c h ild ( re n) fo r w hom r e so urc e is b ein g c o nsid ere d: (1 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ (4 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ ( 2 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ (5 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ ( 3 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ (6 ) _ _ ___ ___ ____ ___ ___ ___ ___/_ _ ___ ___ ___ __ D ate s o f p ro pose d v is it : _ ___ _______________________ ________________________ ______ D oes th e h om e m eet th e fo llo w in g m in im um s ta ndard s fo r a fo ste r fa m ily h om e? ( 1 ) S uit a ble n eig hborh ood Y es N o C om ments : _ ______________________________________ __________________ ______ ( 2 ) A cce ss o r tr a nsp orta tio n to s ch ool a nd c h urc h Y es N o C om ments : _ ______________________________________ __________________ ______ ( 3 ) F unctio nal s m oke d ete cto rs /fir e e xtin guis h ers Y es N o C om ments : _ ______________________________________ __________________ ______ ( 4 ) H om e a nd g ro unds fr e e o f d angers w hic h c o nstit u te h aza rd s Y es N o C om ments : _ ______________________________________ __________________ ______ ( 5 ) F ence e nclo sin g p la y a re a w hen n eig hborh ood h aza rd s e xis t Y es N o C om ments : _ ______________________________________ __________________ ______ ( 6 ) D oors a nd w in dow s s cre ened o r h om e is a ir - c o ndit io ned Y es N o C om ments : _ ______________________________________ __________________ ______ ( 7 ) H om e is c le an Y es N o C om ments : _ ______________________________________ __________________ ______ ( 8 ) A dequate s le epin g a cco m modatio ns ( C hild s h all n ot s le ep w it h a dult s ; b abie s s le ep a lo ne) Y es N o C om ments : _ ______________________________________ __________________ ______ EVA LU ATIO N O F U NRELA TE D V IS IT A TIO N R ESO URC E F O R F O STE R C HIL D DHR-F C S-1 604 A pril, 1 9 90 2 ( 9 ) A dequate s p ace fo r s ic k c h ild Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 0) S afe p la y a re a Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 1) A dequate s to ra ge a nd p re para tio n s p ace fo r f o od Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 2) F am ily is in a gre em ent to k e ep c h il d Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 3) V is it in g r e so urc e p are nts a re o f a ge o f m ajo rit y ; c a n r e ad a nd w rit e Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 4) F am ily m em bers a ppear to b e in g ood h ealt h Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 5) S hall p ro vid e s u perv is io n Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 6) A re o f s u it a ble c h ara cte r Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 7) S hall m ain ta in c o nfid entia l in fo rm atio n a bout c h ild a nd h is fa m ily Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 8) C entr a l R egis tr y c le are d Y es N o C om ments : _ ______________________________________ __________________ ______ ( 1 9) D is cip lin e p olic y h as b een d is c u sse d Y es N o C om ments : _ ______________________________________ __________________ ______ ( 2 0) S ta te m ent b y r e so urc e o f n o f e lo ny/m is d em eanor c o nvic tio ns p er p olic y Y es N o C om ments : _ ______________________________________ __________________ ______ EVA LU ATIO N O F U NRELA TE D V IS IT A TIO N R ESO URC E F O R F O STE R C HIL D DHR-F C S-1 604 A pril, 1 9 90 3 R efe re nce s: ( U se s e para te s h eet if m ore s p ace is n eeded) ( 1 ) Nam e _ _______________________________________ Tele phone # _ ______ ______ D ate o f c o nta ct a nd c o m ments _ __________________________________________ __ ______ _ ___________________________________ _______________________ ___________ ______ ( 2 ) Nam e _ _______________________________________ Tele phone # _ ______ ______ D ate o f c o nta ct a nd c o m ments _ __________________________________________ __ ______ _ ___________________________________ _______________________ ___________ ______ ( 3 ) Nam e _ _______________________________________ Tele phone # _ ______ ______ D ate o f c o nta ct a nd c o m ments _ __________________________________________ __ ______ _ ___________________________________ _______________________ ___________ ______ ( 4 ) Nam e _ _______________________________________ Tele phone # _ ______ ______ D ate o f c o nta ct a nd c o m ments _ __________________________________________ __ ______ _ ___________________________________ _______________________ ___________ ______ H as e ach m em ber o f th e h om e b een in te rv ie w ed? Y es N o Date s o f c o nta cts a nd c o m ments : ( U se s e p ara te s h eet if m ore s p ace is n eede d) _ ___________________ _______ ______ _ ___________________________________ _______________________ ___________ ______ A sse ssm ent o f a bili t y to c a re fo r fo ste r c h ild : _ _____________________ ____________ ______ _ ____________________________________ ______________________ ___________ ______ A sse ssm ent o f r e la tio n sh ip to f o ste r c h ild : _ ________ ________________________ ___ ______ _ ___________________________________ _______________________ ___________ ______ W hat is th e r e la tio nsh ip o f th e fo ste r p are nts to th e v is it in g r e so urc e ? _ __________ ____ ______ ____________________________________ _______________________ ___________ ______ H as th e w ork e r’s p ho ne n um ber a nd b a cku p n um ber b ee n g iv e n in c a se o f e m erg ency? Y es N o D is p osit io n: A ppro ve d D is a ppro ve d _ ___________________________________ ________________ W ork e r’s S ig natu re _ ______________ ______ D ateRelevant article from our knowledge database
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