The visit schedule must mirror the schedule identified by the caseworker in the Visit Referral, DSHS 15-363, taking into consideration the parent and If the parent identified other locations and resources for supervision or child’s availability. transportation, the caseworker must give final approval. Identify each day of the week that a visit is scheduled. Identify the beginning and end time of each visit. Identify the visit location including an address. Note who will be supervising the visit. Identify the child and how they will be transported to the visit. Note where the child will be picked up and the time. Notes where the child will be dropped off. Identify any other possible locations for the visit. Identify other individuals available to supervise or provide transportation. Please include the full name individual’s and date of birth when possible (Individuals must have an approved background check and caseworker approval). Visit Summary and Schedule See directions on the previous page. at the bottom of this page. Document caseworker’s approval VISIT TIME VISIT LOCATION VISIT SUPERVISOR : TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME VISIT LOCATION VISIT SUPERVISOR : TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME VISIT LOCATION VISIT SUPERVISOR : TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME VISIT LOCATION VISIT SUPERVISOR : TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS
The visit schedule must mirror the schedule identified by the caseworker in the Visit Referral, DSHS 15-363, taking into consideration the parent and child’s availability. If the parent identified other locations and resources for supervision or transportation, the caseworker must give final approval. Identify each day of the week that a visit is scheduled. Identify the beginning and end time of each visit. Identify the visit location including an address. Note who will be supervising the visit. Identify the child and how they will be transported to the visit. Note where the child will be picked up and the time. Notes where the child will be dropped off. Identify any other possible locations for the visit. Identify other individuals available to supervise or provide transportation. Please include the individual’s full name and date of birth when possible (Individuals must have an approved background check and caseworker approval). Visit Summary and Schedule See directions on the previous page. Document caseworker’s approval at the bottom of this page. VISIT TIME : VISIT LOCATION VISIT SUPERVISOR TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME : VISIT LOCATION VISIT SUPERVISOR TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME : VISIT LOCATION VISIT SUPERVISOR TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS VISIT TIME : VISIT LOCATION VISIT SUPERVISOR TRANSPORTATION PICK-UP TIME / LOCATION DROP-OFF TIME / LOCATION OTHER LOCATION OPTIONS OTHER SUPERVISION / TRANSPORTATION OPTIONS