Lantern Weekly Residential Check In
Complete this form at your weekly check in at each of the Lantern Houses.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time Of Check
*
Staff Member Completing Check
*
First Name
Last Name
House Number
*
Was Client at home?
*
Yes
No
Outside House appearance
*
Great
OK
Bad
Terrible
Describe any specific issues
Inside House appearance (no dishes in the sink, dirty laundry isn’t piled up, etc).
*
Great
OK
Bad
Terrible
Describe any specific issues
Was all signage in place
*
Yes
No
Were emergency items in place (med kit, fire extinguisher)
*
Yes
No
Upload Any Relevant Images Below
Please ensure there are no clients or children in the shots
State and Concerns or Suggested Follow Ups
Submit
Should be Empty: