Requested Foster Home Inspection Check List - State Of Florida Department Of Children And Families
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1
2PURPOSE
RESULTS
STATE OF FLORIDA
___ REQUESTED ROUTINE
DEPARTMENT OF CHILDREN AND FAMILIES
___SATISFACTORY
REQUESTED FOSTER HOME
___ REINSPECTION
___INCOMPLETE
INSPECTION CHECK LIST
___UNSATISFACTORY
NAME OF PARENT(s) _______________________
________________________________
CORRECT VIOLATIONS BY
___NEXT ROUTINE
(Last name)
(First name)
INSPECTION
LOCATION ADDRESS_________________________________CITY_____________________
OR
___ 8 AM ON ______________
STATE FL ZIP CODE_________
E-MAIL __________________________________
(DATE)
HOME PHONE________________________ WORK PHONE __________________________
MAXIMUM # OF FOSTER
BEGIN TIME
END TIME
DATE
POSITION NUMBER
EHD NUMBER
CHILDREN_______
-51-
CURRENT OCCUPANCY
(FOSTER CHILDREN) _____
Items marked “Out” below are non-compliant with Chapter 65C-13 of the Florida Administrative Code related to the DCF licensure of
Substitute Care of Children. Notification of these non-compliant items will be provided to the Department and Children and Families
(DCF) by copy of this report.
WATER SUPPLY & WASTE WATER
PLUMBING
GARBAGE & RUBBISH DISPOSAL
In Out NO NA
In Out NO NA
In Out NO NA
__ __
__ 1. Private Well – routine testing
__ __
9. Bath clean & working
__ __ __
16. Collection frequency
__ __
__ 2. Private Well – results absent
__ __
10. Toilet clean & working
__ __ __
17. Garbage placed in
O
__ __
3. Hot water at a max. of 120
F
receptacle
VECTOR CONTROL
O
__ __
4. Hot water At 100
F min.
In Out NO NA
__ __ __
18. Wet garbage in fly
__ __
11. Effective control measures
tight container
FOOD HOLDING TEMPERATURE
__ __
12. Creation of conditions
__ __ __
19. Garbage areas clean
In Out NO NA
__ __
13. Rodent/Rat Proof
__ __
5. Food storage equipment
__ __
14. Outside openings screened
O
__ __ __
6. Cold food at 41
F or lower
O
__ __ __
7. Hot food at 140
F or higher
SEWAGE
__ __
8. Thermometer accurate &
In Out NO NA
provided in refrigerator
__ __
__ 15. Onsite septic system operational
per 64E-6
Marking Key: IN = the act or item was observed to meet standards; OUT = the act or item was observed not to meet standards; NO = the act or item was not
observed to be occurring at the time of inspection; NA = the act or item is not performed by the facility or not part of the operation
Comments:
CHD Inspector:
Copy Received by:
Date:
Office Phone Number:
DCF FH Check Sheet 01-01-12
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