Visitation Notes Form

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Cautionary Note

This report is based on observation notes that have been prepared by Fremont Connections Staff.

Observers are instructed to record what happens during parent-child contacts and are required not to include opinions and judgements.

Visitation Notes

Date

CASE NAME

ROOM

LEVEL

CHILD NAME

DATE OF BIRTH

CHILD NAME

DATE OF BIRTH

CHILD NAME

DATE OF BIRTH

CHILD NAME

DATE OF BIRTH

VISITING PARTY

ARRIVAL TIME

RELATIONSHIP

CUSTODIAL PARTY

ARRIVAL TIME

RELATIONSHIP

NEED TO KNOW

TOPIC

CONDITION OF CHILDREN AND ADDITIONAL CHECK-IN COMMENTS

DESCRIBE INITIAL INTERACTION WITH CHILD/CHILDREN

DESCRIBE DEMEANOR/INTERACTION OF VISITING PARTY

DESCRIBE SEPARATION

VISIT END TIME

NARRATIVE OF VISITATION

MONITOR #

Date

DIRECTOR SIGNATURE

Date

HAVE YOU MONITORED VISIT BEFORE

Yes

No

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