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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 ate
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Next: ADOPT- 230, Adoption Expenses Previous: Alaska P-455 Affidavit of Reasonable Investigation
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