Special Needs Child Welfare Home Visit Checklist
Date of Visit
Child's Name
Caregiver(s) Name(s)
Address
Contact Number
Home Environment
Safe
Clean
Accessible for special needs
Child has personal space
Notes
Child's Health & Medical Needs
Taking prescribed medication
Regular doctor visits
Receives specialized therapy
Notes
Education & Development
Attending school/center
IEP/Individual Plan in place
Support services available
Notes
Caregiver Interaction
Positive interaction
Caregiver is responsive to needs
Demonstrates understanding of child's special needs
Notes
Child's Emotional & Social Well-being
Appears happy
Engaged in activities
Interaction with peers/siblings
Notes
Follow-up Actions / Recommendations