Form LIC 03. Resource Family Home Health And Safety Assessment Checklist Document For Agency Use Only - California

Form LIC 03 is a document for agency use only in California. Its purpose is to provide an assessment checklist for evaluating the health and safety of a resource family home during the approval process.

This form is typically completed by a licensing agency representative or social worker who conducts an inspection of the resource family home. It includes sections to assess various aspects of the home, such as living conditions, safety measures, cleanliness, and the presence of any potential hazards.

The form is not intended for the applicant to complete but rather serves as a tool for the evaluating agency. It helps ensure that the resource family home meets the required health and safety standards before approval.

Application Example: After an individual or couple completes their resource family application in California, a licensing agency representative may use Form LIC 03 to conduct a home assessment. By completing the checklist and documenting the findings, the agency can evaluate the suitability of the home for fostering children.

Related Forms: Form LIC 01A, the Resource Family Application, is a related form that gathers general information about the applicant. Form LIC 03 focuses specifically on the health and safety assessment of the resource family home.