The following checklist has been developed to help you determine
when you are ready for a home visit. The 4C counselor will
need to observe the following things before you can be placed
on the registry. Take a few moments and answer these questions.
When you can check yes to each of them, you are ready for
your home visit.
Health
& Safety Precautions
Yes
No
Have you installed a working smoke detector on each
level/floor where child care is provided?
Yes
No
Do you have a working fire extinguisher that has a gauge
or visible expiration date?
Yes
No
Have you completed and posted the family fire escape
plans showing that there are two exits from each floor
where child care is provided?
Yes
No
Have you posted the numbers for fire, police, life squad
or 911 and poison control by your telephone on each
level where child care is provided?
Yes
No
Do you have a portable fire ladder in place which leads
to ground level (if windows or doors do not lead to ground
level, roof, balcony or fire escape)?
Yes
No
Are the windows that are used as second exits at least
20" wide x 24" in height?
Yes
No
Do you have a gate, or door that locks, to protect all
stairways that the children will come in contact with?
Yes
No
Do you have a flashlight in working order in an accessible
location or other safe emergency lighting? (Candles and
oil lamps are not acceptable.)
Yes
No
Have you covered all unused electrical outlets
with protective coverings?
Yes
No
Do you have the following first aid supplies located
in a container that is easily accessible when needed?
Can you transport this container?
Adhesive Bandages (Band-Aid)
Adhesive Tape
Antibacterial Soap
Assorted Sized Gauze Pads
Cotton Swabs
(Q-tips)
Disposable Gloves
Dosing Spoon/or Cup
Large Safety Pins
Roller Bandages (gauze)
Scissors
Sling (scarf,
bandana, cloth diapers)
Small Hand Towel
Syrup of Ipecac
Thermometer
Powdered Milk (1
cup)
Tweezers
Ice pack
Yes
No
Have you contacted a neighbor, friend or relative who
has agreed to be called and arrive at your house within
5 minutes to help in case of emergency?
Safety
Hazards
Yes
No
Have you moved all cleaning supplies, dangerous chemicals,
and medications out of the reach of children or installed
a childproof latch so they cannot come in contact with
these items?
Yes
No
Have you removed any portable heaters, wood stoves or
fans out of the reach of children, or developed a plan
so that the children cannot come in contact with them?
Yes
No
Have you inspected your home inside and out for items
sharp, rusted or dangerous that could be potentially harmful
to children?
Yes
No
Do you have a copy of your Water Safety Policy
and sample permission slips completed?
Yes
No
Do you have the required pool equipment such as, rings,
hooks, or pole?
Yes
No
Do you have a pool alarm?
Yes
No
Do you have a non-climbable fence surrounding the pool,
that locks or for above ground pools, ladders that fold
up or are removable, to make the pool inaccessible?
Yes
No
*If you plan to use an above-ground, in-ground pool,
or lake/pond (wading pools/sprinklers excluded) you will
need to provide the home visitor copies of your Water
Safety Policy and permission slips.
Yes
No
Have you securely stored and locked any fire arms or
weapons?
Home
Environment
Yes
No
Do you have enough space indoors for the children to
play?
Yes
No
Do you have outdoor space for the children that is free
from hazards and traffic?
Yes
No
Do you have age appropriate toys and activities for
the children?
Yes
No
Do you have child size furniture and equipment?
Yes
No
Have you considered where children will sleep when appropriate?
Yes
No
Have you considered where you will toilet/diaper the
children?
