Form CFS452-5 "Safety Plan for Pools, Hot Tubs, Ponds, and Other Potential Water Hazards" - Illinois

What Is Form CFS452-5?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2010;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS452-5 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS452-5 "Safety Plan for Pools, Hot Tubs, Ponds, and Other Potential Water Hazards" - Illinois

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CFS 452-5
State of Illinois
Rev 9/2010
Department of Children and Family Services
SAFETY PLAN FOR POOLS, HOT TUBS, PONDS,
AND OTHER POTENTIAL WATER HAZARDS
Foster Parent(s)
, home/yard includes the
following: (check all that apply)
Swimming Pool
Hot Tub
(Dimensions
)
Pond (within 200 feet of play area)
Other (specify)
Regarding the area(s) checked above, foster parent agrees to comply with all water safety standards in
Rule 402* and provide the following safety measures: (check all that apply)
Current CPR certification
Keep area fenced and locked at all times unless an adult is present to supervise (describe
area)
Keep gate locked at all times unless an adult is present to supervise (describe location of
gate)
Keep pool ladder removed and/or locked at all times unless an adult is present to
supervise (specify where ladder is stored)
Maintain an operable locking cover, which will be locked at all times unless an adult is
present
Only allow children in the yard with supervision
Other (specify)
* See 402.8(d) for specific safety requirements, e.g. fences, locking covers, and so forth.
Foster Parent agrees to notify the Licensing Representative of any additions of swimming pools, hot
tubs or ponds or changes in safety measures. Failure to ensure safety of foster children may result
in a licensing violation citation.
Foster Parent
Date
Foster Parent
Date
Licensing Representative
Date
Licensing Supervisor
Date
CFS 452-5
State of Illinois
Rev 9/2010
Department of Children and Family Services
SAFETY PLAN FOR POOLS, HOT TUBS, PONDS,
AND OTHER POTENTIAL WATER HAZARDS
Foster Parent(s)
, home/yard includes the
following: (check all that apply)
Swimming Pool
Hot Tub
(Dimensions
)
Pond (within 200 feet of play area)
Other (specify)
Regarding the area(s) checked above, foster parent agrees to comply with all water safety standards in
Rule 402* and provide the following safety measures: (check all that apply)
Current CPR certification
Keep area fenced and locked at all times unless an adult is present to supervise (describe
area)
Keep gate locked at all times unless an adult is present to supervise (describe location of
gate)
Keep pool ladder removed and/or locked at all times unless an adult is present to
supervise (specify where ladder is stored)
Maintain an operable locking cover, which will be locked at all times unless an adult is
present
Only allow children in the yard with supervision
Other (specify)
* See 402.8(d) for specific safety requirements, e.g. fences, locking covers, and so forth.
Foster Parent agrees to notify the Licensing Representative of any additions of swimming pools, hot
tubs or ponds or changes in safety measures. Failure to ensure safety of foster children may result
in a licensing violation citation.
Foster Parent
Date
Foster Parent
Date
Licensing Representative
Date
Licensing Supervisor
Date