The following forms and resources are for your use. Most are samples, but others can (or are required to) be printed and posted and/or filled out. They are separated into forms that relate to the facility and those that relate to the resident.
Facility/provider-related form
- Application for employment (sample form)
- Checklist for adult foster care license
- Complaint procedure (required to be posted in all foster homes)
- for adult foster home licensees
- Correcting documentation errors
- DD adult foster home forms on the DHS/OHA website
- Emergency phone number list (sample)
- Emergency plan (sample template)
- Emergency supply list (FEMA brochure)
- Fire evacuation and smoke/carbon monoxide detector checks (sample)
- Hot water can burn (Oregon Burn Center brochure)
- House rules (sample)
- Menu (sample)
- Provider/staff training log (sample)
- References
- Residency Agreement form
- Resident Bill of Rights (required to be posted in all foster homes)
- Substantiated abuse notification
- Substitute caregiver orientation record (sample)
- Tips for meeting training hour requirements
- Training requirements summary
- Websites/resources for foster care providers
Resident-related forms
- 1:1 staffing record (sample)
- Activities record (sample)
- Aspiration/choking protocol (sample)
- Balancing test for psychotropic medications (sample)
- Constipation protocol (sample)
- Dehydration protocol (sample)
- Drug disposal record (sample)
- Financial record/ledger (sample)
- General protocol (sample)
- Incident report (sample)
- Medication administration record (sample)
- Personal property record (sample)
- Physician/health professional visit and order form (sample)
- Pica protocol (sample)
- Resident record table of contents (sample)
- Seizure protocol (sample)