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Revise as often as necessary. If children are separated also include a plan for sibling visitation. Different forms should be completed when the children have different visitation plans. Child ren Name s This plan with Supervision Required is effective Yes through No By Whom Place of visit Frequency of visits Hours Length of visits Transportation Arrangements Special Considerations Phone Calls Allowed With Whom Mail/Email Allowed From Whom Monitoring Needed Send All Mail/Email to Signatures Child/Youth if appropriate Parent s Social Worker Others Date DSS-5242 02/06 Family Support and Child Welfare Services. VISITATION and CONTACT PLAN For each child state type time level of supervision frequency duration location of visits and transportation arrangements. Revise as often as necessary. If children are separated also include a plan for sibling visitation* Different forms should be completed when the children have different visitation plans. Child ren Name s This plan with Supervision Required is effective Yes through No By Whom Place of visit Frequency of visits Hours Length of visits Transportation Arrangements Special Considerations Phone Calls Allowed With Whom Mail/Email Allowed From Whom Monitoring Needed Send All Mail/Email to Signatures Child/Youth if appropriate Parent s Social Worker Others Date DSS-5242 02/06 Family Support and Child Welfare Services. VISITATION and CONTACT PLAN For each child state type time level of supervision frequency duration location of visits and transportation arrangements. Revise as often as necessary. If children are separated also include a plan for sibling visitation* Different forms should be completed when the children have different visitation plans.

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