STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
FACILITY VISIT CHECKLIST
CHILD CARE CENTERS AND INFANT CENTERS
Review facility file prior to visit. Check to see that the following information has been updated, if required, and contained
in the file. Indicate the date the information was submitted to the licensing agency in the space provided for each item
requested.
LICENSE ANNIVERSARY DATE
ON FILE
DATE
REQUESTED
DATE
RECEIVED
Application Information (LIC 215)
Criminal Record Clearance and Child Abuse Index Checks (LIC 198) (updated for current
staff subject to fingerprint requirements)
Licensee Affidavit Regarding Persons Exempt From Fingerprint Requirements (if not on
LIC 500)
Administrative Organization (LIC 309)*
Estimated Monthly Operating Budget (LIC 401), Budget Information (LIC 420), Financial
Statement and Information (LIC 403, LIC 404)
Articles of Incorporation, Constitution and Bylaws (if applicable)
Partnership Agreement (if applicable)
Designation of Administrative Responsibility (LIC 308)*
Personnel Report (LIC 500) Updated*
Facility Floor/Plot Plan (LIC 999)
Verification of Qualifications of Facility Director
Emergency Disaster Plan (LIC 610)
Disaster and Fire Drills (every 6 months)
Plan of Operation
Admissions Policies and Procedures/Fee Schedule
Health Screening Report - Facility Personnel (LIC 503)
Daily Activity Schedule
Fire Clearance (consistent with terms and limitations of license)
Bacteriological Analysis of Private Water Supply (if applicable)
License Fee Received
NOTES AND COMMENTS
*Other verifying documents may be substituted for these LIC forms
LIC 9118 (11/03)
