Appendix Lii HOME SAFETY CHECKLIST (FOSTER CARE & ADOPTIVE APPLICANTS IN ONTARIO) GUIDELINES TO CHILDREN S AID SOCIETIES/ADOPTION PRACTITIONERS AND PRIVATE FOSTER/ADOPTION AGENCIES IN COMPLETING THIS FORM: It is intended that the resource worker review this form with foster/adoptive applicant(s) during the initial stages of the homestudy assessment. The purpose is two-fold: 1) to enable, to the extent possible, that a child be placed in a safe environment; and 2) to raise awareness and educate applicant(s) about safety issues when a child is living in the home. Adoption and foster care workers must complete the safety assessment as part of the homestudy process with a follow up safety review if there were areas of: i) non compliance; and/or ii) to establish home as placement ready after designation of recommended or approved Each children s aid society may have safety requirements not stated on the forms. Particular characteristics of the child will also affect safety expectations, for example families for older children will not need to comply with crib standards or car seats. Each agency may choose to add areas at the end of each section to comply with specific policies and procedures regarding required practice. The SAFE homestudy requires an assessment of the applicant s Physical/Social Environment and the review of this document will assist in completing this section of the homestudy. Cleanliness/Orderliness/Maintenance strength is defined in that the home exterior and property are well kept, home interior is clean and comfortable, home reflects consistent care and attention Safety strength is defined as no safety issues notes on agency s safety checklist, applicants are safety conscious and knowledgeable about child safety Furnishings strength is defined as home adequately furnished, clean, sturdy and functional furniture, functional and reliable appliances, adequate supply of house ware Play area/equipment/clothing strength is defined as adequate proper clothing, toys and equipment are age appropriate and in good condition, adequate indoor and outdoor play area Household pets strength is defined as pets in the home is/are treated well by family members, family does a good job providing the accommodations, diet, grooming and veterinary needs of their pets, pet is trained and comfortable with children NOTE: WITH REGARD TO RURAL, REMOTE OR FAR NORTHERN COMMUNITIES Some of the safety expectations on this checklist may not be applicable in rural, remote or far northern communities. Foster care and adoption workers should use judgment and common sense when faced with these situations. Alternate safety measures may be applicable in some cases, for example, specific cultural practices. These will need to be identified and included in each applicable section of the home safety checklist and in section (i) n-compliance. EXAMPLES OF SOME OF THE SAFETY REQUIREMENTS THAT MAY NOT APPLY INCLUDE: Telephone in the home (telephone lines may not exist) Fire Extinguishers and Carbon Monoxide Detectors (may not be available for purchase) Fire Departments (may not exist) Water inspection (may not have access to testing)
1. Household Requirements: Designated spaces for informal living, dining, food preparation and storage; separate rooms for sleeping and bathing. Stable supply of heat. Circle method of heat used: Gas Oil Wood Other: Garbage, refuse and other wastes disposed of in a way that does not constitute a health hazard. Mirrors and other wall attachments, large pieces of furniture (i.e. dressers, television sets) are fixed securely, to prevent toppling over. Maximum temperature of hot water in bathroom 49 degrees Celsius or less. Steps or railings sturdy, appropriately spaced and in good repair. Electrical outlets covered and not overloaded. If used, extension cords in good repair. Electrical appliances and cords out of young children s reach. Exits and stairways gated or otherwise secured for infants and young children. Rugs and other moveable floor coverings safely secured. Knives, scissors and other sharp instruments kept out of the reach of young children. Windows, screens and balcony doors in high-rise apartment buildings secured by safety catches. Cords on blinds and drapes constructed without loops and kept out of the reach of young children. Unused refrigerators/freezers/stoves stored with doors removed. Provide a BRIEF description of home and surrounding area: (i.e. urban/rural, single dwelling/apartment, proximity of schools/community services etc.) 2. Means of Communication: Telephone access available. List of emergency telephone numbers readily accessible.
3. Fire Safety Smoke Detector(s) in working order located on each floor and outside of bedrooms. Written Fire Evacuation Plan established and regularly reviewed with all family members. Plan is posted. Flashlight(s) in working order; easily accessible in emergency. Fire extinguisher(s) in working order; not less than 2½ pounds; for Class B and C fires. Carbon Monoxide detector(s) located on bedroom level of home. Exits and hallways well lit and uncluttered. Fireplace screens or front guards in use; combustible deposits removed regularly. Matches and lighters are inaccessible to children. Home Insurance Provider: Coverage: Reminder insurance mandatory and their responsibility to maintain on annual basis. 4. Sleeping Arrangements: (these standards apply to foster child and/or child on adoption placement). Infant cribs in compliance with government safety standards. Each child has a bed with a clean mattress that is suitable for the age of the foster child and with bedding that is appropriate to the weather and climate, allowing for variations according to local cultural traditions (e.g. bedrolls.) Bedrooms occupied by children do not have external door locks. Locks from inside are made inoperable. Bedrooms occupied by children have a window. Clothing storage space available for child s personal belongings. bedroom designated for a child is in a building detached from the home, an unfinished attic, unfinished basement, or a stairway hall. A child over six years of age will not share a bedroom with a child of the opposite sex (unless in the assessment of the worker/practitioner and caregiver/parent this arrangement would reduce anxiety and normalize the experience during the initial stages of placement). A child will not share a bedroom with an adult couple or adult of the opposite sex unless the foster child is ill, an infant/young child (under the age of 2 years), or has needs that require the child be placed in the same room. Top bunk bed cannot be used by child under six (6) years. waterbed for child under six (6) years. 5. Firearms: All guns to be stored unloaded and secured with a trigger lock, in a locked container or room, or by disabling the firearm. All other firearms for example, bows and hunting sling shots are made inoperable when not in use and are stored in locked cabinets, inaccessible to children.
Ammunition stored separately from firearms in containers in locked compartments All adults over the age of 18 years using firearms have a Firearms License. 6. Medicines and Hazardous Substances: Medications and other potentially hazardous pharmaceutical substances are locked inaccessible to children. Medication stored as directed and in original labeled container and or blister packs. Unused or expired medications kept in a separate and secure storage area. Other potentially hazardous household substances (e.g. bleach, cleaning fluids, pesticides) are inaccessible to children. Alcohol is inaccessible to children. 7. Specific Safety Precautions: Swimming pools on property are fenced and secured with a locked gate and /or meet identified jurisdictional by-laws. Barriers in place to restrict access to ponds on the property. Trampolines/ outdoor equipment safety/supervision discussed Baby walkers and jolly jumpers cannot be used. Precautions in place to protect against 2 nd hand smoke. 8. Pets: Pets have been inoculated and shots are up-to-date. Pet is permitted in Ontario. 9. Automobile Safety: Valid Driver s License for each person driving children. Equipped with child safety seats for infants/young children. Equipped with booster seats for older children, less than 8 years of age or weighing less than 80 lbs or 4 9. Equipped with safety seat belts for each person. Car Insurance Provider: Amount: Reminder insurance mandatory and their responsibility to maintain on annual basis. 10. Water Source: Municipal Water System Well/Cistern: Date of last test:
Results: 11. Educational Undertaking: I/We undertake to inform and instruct a child(ren) about: - potential danger of certain types of farm equipment structures and livestock (where applicable) - water safety and potential dangers of specific water hazards i.e. wells, water troughs, lakes, rivers, reservoirs, culverts, tubs, ponds, swimming pools, Jacuzzi tubs etc. - potentially dangerous situations involving family animals - dangerous Internet sites and ensure protective screening programs are in place so that Internet adult sites are inaccessible to children - ensure adult videos, and other such adult materials are as inaccessible to children as possible - Fire Evacuation Drill (with designated outdoor meeting area) practiced with all family members on a quarterly (every 3 month) basis - potentially dangerous house plants, some for example are: Poinsettia Elephant s Ear Mistletoe Rosary Pea Dieffenbachia Castor Bean Oleander Narcissus (bulbs) Arnica Hyacinth (bulbs) Philodendron Daffodil (bulbs) Calla Lily
n-compliance Comment on areas where applicant(s) are unable to comply. Identify plan for alternate safety measure or waiver of compliance, with reasons. Area of n-compliance Plan for Compliance or Alternate Safety Measure or Waiver Date of Compliance Name of Applicant(s) Address: I/We certify that the information provided in this checklist is accurate to the best of my/our knowledge and belief. Resource Applicant 1: (Signature) Resource Applicant 2: (Signature) I have reviewed this document with the applicants. Foster Care Worker/Adoption Practitioner: (Signature) Resource Supervisor (Signature) Date Reviewed: