Foster Care Weekly Log of Functioning
Child's Name
First Name
Last Name
Week of: (Sunday - Saturday)
-
Month
-
Day
Year
Date
Please describe the supervision of your foster youth this week (remember no unsupervised time during the first 30 days of placement):
Please rate how well your child met household expectations this week (i.e. chores, bedtime, school, etc.)
Not at all
Some of the time (50%)
Most of the time (75%)
Consistently meets expectations
Positive Behaviors Seen This Week (Check all that apply):
Cooperative
Interacted appropriately with family members
Met expectations
Played well with others
Accountable
Followed direction
Accepted re-direction
Pleasant
Other
Rewards for Positive Behaviors seen this week:
Areas of Concern (Check all that apply):
AWOL
Sexualized behavior
Unable to re-direct
Poor school performance
Physically aggressive
Argumentative
Oppositional
Verbally aggressive
Self-harm
Withdrawn / Isolated
None Noted
Other
Please provide more detail about the areas of concern this week including consequences:
Please list any appointments your foster youth had this week not with Applewood. Please include the date, type of appointment and reason/outcome:
Please list any extra curricular activities your foster youth participated in this week. Please include date, location, participants and activity/event:
Did your foster youth take their medication as prescribed this week?
Yes
No
N//A
Please indicate which medications, day and time of day medication was NOT administered as prescribed:
Please list respite date and location for this week:
Foster parent signature:
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: