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DHS-8474 <br /> <br /> 1 <br /> <br />Child Foster Care Home Safety Checklist – Guidance <br />This document is to provide clarification regarding items on the home safety checklist. It can be used by <br />licensing agencies completing initial and ongoing assessment and placing agencies for the purpose of an <br />emergency relative placement. <br />Applicants or license holders may also find these clarifications helpful in preparing for initial licensure and <br />meeting ongoing home safety requirements. Generally, a variance should not be approved for items on the <br />home safety checklist but may be considered on a case-by-case basis and after consultation with licensing <br />triage. <br />Emergency Procedures <br />1. A list of emergency phone numbers - it is recommended that applicants and license holders use the <br />DHS Foster Care Emergency Escape Plan form. If not using that form, the emergency procedures <br />document: <br />o Must include 911 and local phone numbers for non-emergency police, fire departments, and <br />poison control. <br />o May also include phone numbers for the family’s local clinic or hospital, mental health crisis, <br />family emergency contacts, placing worker contact information, and the placing county’s after- <br />hours/emergency number. <br />o Must be posted in a location known by everyone in the home and a copy kept in the family’s file. <br />2. A written fire/emergency escape plan - it is recommended to use the DHS Foster Care Emergency <br />Escape Plan form. If not using that form, the fire/emergency escape plan must document: <br />o A meeting place outside to determine if anyone is missing <br />o Where the family would meet during a storm or tornado <br />o Where the family would take temporary shelter if needed <br />o Locations of smoke detectors and fire extinguishers <br />o An acknowledgment for child foster care from all applicants and license holders that for <br />placement of a child at risk of starting fires, they will comply with locking and removing all <br />fire-starting objects and discuss with the case manager the need for a supervision plan <br /> The form must be clear and list specific addresses, if applicable (not “grandma’s house”). If areas on <br />the form aren’t applicable, indicate this, rather than leave it blank. The plan must also include a floor <br />plan clearly indicating the location of doors and windows and emergency evacuation routes with <br />arrows. The plan must include all levels of the home, including unfinished basements. This must be <br />posted in a location known by everyone in the home and a copy kept in the family’s file. <br />Page 190 of 379