DEPARTMENT OF CHILDREN AND FAMILIES
Division of Safety and Permanence
Staff / Volunteer Orientation Documentation – Group Homes
Use of form: This form is voluntary; however, completion of this form will facilitate the licensing process and help verify compliance with DCF
57.14(6), 57.16(1) and 57.17(2)(i) of the Wisconsin Administrative Code. Personally identifiable information gathered on this form will be used
only to verify compliance with licensing rules. Personal information you provide may be used for secondary purposes [Privacy Law, s.
15.04(1)(m), Wisconsin Statutes].
Instructions: Orientation must be documented for each new employee within their first week of hire. Orientation must be documented for
each new volunteer before the volunteer begins performing activities. Upon completion of orientation, trainer and staff / volunteer shall initial
and date the spaces that correspond to each completed item. The completed form shall be placed in the staff / volunteer record for review by
the licensing representative.
Name – Staff / Volunteer (Last, First, MI)
Position
Start Date (mm/dd/yyyy)
Name – Trainer
Position – Trainer
Trainer Employee
STAFF REQUIREMENTS
Initials Date / Time Initials Date / Time
Job description created under s. DCF 57.17(1)(a). The job
description shall be signed and dated by the staff member upon
receipt by the staff member. [57.16(1)(a)]
Program statement as specified under DCF 57.05(1). If licensed
for respite care, see 57.35(3). [57.16(1)(b)]
Written policies and procedures as specified under DCF
57.05(2)(a) – (d). If licensed for respite care, see 57.35(3).
[57.16(1)(b)]
Emergency planning and preparation procedures as specified
under DCF 57.06(1). [57.16(1)(b)]
Personnel policies and procedures as specified under DCF
57.17(1). [57.16(1)(b)]
Requirements of child abuse and neglect reporting specified under
s. 48.981(2) and (3), Wis. Stats., and information on how to
identify and report abuse or neglect situations. [57.16(1)(c)]
Instruction on how to use fire extinguishers, and on emergency
and evacuation procedures. [57.16(1)(d)]
Any other information that would orient the staff member to the
group home. [57.16(1)(e)]
Trainer Employee
VOLUNTEER REQUIREMENTS
Initials Date / Time Initials Date / Time
Activities that the volunteer may perform as specified in the
personnel policies and procedures. [57.14(6)(a)]
Confidentiality requirements specified under DCF 57.39.
[57.14(6)(b)]
Child abuse and neglect reporting requirements specified under
DCF 57.18(1). [57.14(6)(b)]
DCF-F-CFS2380-E (R. 08/2012)
