SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER ... · SECTION 3: CURRENT CHILD CARE...

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License/Registration/Approval No.: South Carolina Department of Social Services Child Care Licensing and Regulatory Services SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER CHECKLIST Name of Facility: County: Date: DSS Form 2964 (MAR 10) Edition of MAR 94 is obsolete. To be completed by the child care facility operator – include emergency personnel For DSS Child Care Licensing Only To Be Collected/ Verified by Licensing Specialist To Be Maintained in Employee File Name Position Date of Birth Social Security Number Primary Age Group Assigned Years of Experiences Training Record BBP Training All Policies Fingerprint Results SLED Results TB Test DSS Form 2926 DSS Form 2925 DSS Form 2924 DSS Form 2901 First Aid CPR Infant/Child Ed. Level Verified* Employment End Date Employment Start Date Days/ Hours on Duty Example: M-F/8-5 Total Staff: (Page of ) *Verify educational level by listing the diploma or degree Use additional pages if necessary

Transcript of SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER ... · SECTION 3: CURRENT CHILD CARE...

Page 1: SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER ... · SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER CHECKLIST Name of Facility: County: Date: DSS Form 2964 (MAR 10)

License/Registration/Approval No.:

South Carolina Department of Social Services

Child Care Licensing and Regulatory Services

SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER CHECKLIST

Name of Facility: County: Date:

DSS Form 2964 (MAR 10) Edition of MAR 94 is obsolete.

To be completed by the child care facility operator – include emergency personnel For DSS Child Care Licensing Only

To BeCollected/Verified byLicensingSpecialist

To Be Maintained in Employee File

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Example:M-F/8-5

Total Staff: (Page of ) *Verify educational level by listing the diploma or degree Use additional pages if necessary

FACILITY VISIT CHECKLIST CHILD CARE CENTERS AND INFANT … · FACILITY VISIT CHECKLIST CHILD CARE CENTERS AND INFANT CENTERS Review facility file prior to visit Check to see that

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