Notes Section 4: Family Functioning Family Functioning (INTAKE) Case: (Case Name) Individual: Is the home a health or safety hazard for the individuals living there? Broken windows Dangerous animals in the home Human/animal feces Meth lab Dangerous chemicals accessible Inadequate heat in winter Mold infestation Exposed wiring Infestation of rodents/insects Spoiled food Fire safety hazards Inoperable sanitation Unsafe space heaters Hoarding Insufficient shelter (includes Unsupervised with loaded Holes in floor or walls homeless) guns/weapons Medications not secure No issues What corrective action has caretaker made for any checked item?
Notes Section 4: Family Functioning Family Functioning (INTAKE) Case: (Case Name) Individual: Is the home a health or safety hazard for the individuals living there? Broken windows Dangerous animals in the home Dangerous chemicals accessible Exposed wiring Fire safety hazards Hoarding Holes in floor or walls Human/animal feces Inadequate heat in winter Infestation of rodents/insects Inoperable sanitation Insufficient shelter (includes homeless) Medications not secure Meth lab Mold infestation Spoiled food Unsafe space heaters Unsupervised with loaded guns/weapons No issues What corrective action has caretaker made for any checked item?
ADT%20Concurrent%20CPS%20DV%20Assessment.docx