Preschool Inspection Form

2018 Inspection Form Blank Download

Inspection Form

This form is used for an inspection of a preschool center. The FLOCS inspection process is one way in which we can validate quality schools against a recognized set of quality standards that are respected by every agency within our state and much of our nation.

Step 1 of 2 - School Information

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FLOCS/ILCS ID Code:*
Lookup
Center Name:*
Street*
City*
State*
Postal Code*
Phone*
Date of Inspection*
Date Format: MM slash DD slash YYYY
Time Inspection Started*

: HH

MM
Capacity*
Please enter a number from 0 to 999.
Current Enrollment:*
Inspector
First Last
Inspector*
Reason for Inspection*
1. Governance
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
1.a. 'Certified by FLOCS' on all publications*
1.a Explanation*
1.b. Proof of Attendance at Business Meetings*
1.c. Permanent School Closing*
1.c Explanation*
1.d. Quarterly Self Inspections Conducted*
1.d Explanation*
1.e. Change of Status Form*
1.e. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
2. Curriculum and Instruction
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
2.a Religious Instruction Provided*
2.a. Non-Compliance Details
2.b. Designed for Age Level of Children*
2.b. Non-Compliance Details
2.c. Daily Time Schedule*
2.c. Non-Compliance Details
2.d. Weekly Lesson Plans Used*
2.d. Non-Compliance Details
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
3. Staff
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
3.a. Professing Christians*
3.a. Non-Compliance Details*
3.b. Current Director's Credential on File*
Director's Credential Expiration Date:*

Date Format: MM slash DD slash YYYY
3.c. DCF 45 Hour Training*
3.c. Non-Compliance Details*
Please list all staff that do NOT have their 45 hour DCF training.
Last Name First Name
3.d. Annual 15 Hour In-Service Training*
3.d Non-Compliance Details*
Please list all staff that do have their 15 in-service hours.
Last Name First Name
3.e. Provides Direct Supervision of Students*
3.e. Non-Compliance Details*
3.f. Proper Background Checks Completed*
3.f. Non-Compliance Details*
Please list all staff that do NOT have background checks.
Last Name First Name
3.g. Affidavit of Good Moral Character*
3.g. Non-Compliance Details*
Please list all staff that do have affidavits.
Last Name First Name
3.h. Annual Child Abuse Training Signed*
3.h. Non-Compliance Details*
Please list all staff that do NOT have signed child abuse training.
Last Name First Name
3.i. Record of Date, Agenda & Attendance of Staff Meetings*
3.i. Non-Compliance Details*
3.j. Staff Handbook Available*
3.j. Non-Compliance Details*
3.k. Personnel Records Available*
3.k. Non-Compliance Details*
3.l. Personal Hygiene Evident*
3.l. Non-Compliance Details*
3.m. Sufficient Staff-to-Student Ratio/Sub*
3.m. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
4. Student Admission Policies And Records
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
4.a. Enrollment Information on File*
4.a. Non-Compliance Details*
4.b. Emergency Information*
4.b. Non-Compliance Details*
4.c. Immunizations Current*
4.c. Non-Compliance Details*
4.d. Current Physical Exam (or Exemption Status)*
4.d. Non-Compliance Details*
4.e. Written Authorization for Medication*
4.e. Non-Compliance Details*
4.f. Identification Procedure Followed*
4.f. Non-Compliance Details*
4.g. Student Records Accessible*
4.g. Non-Compliance Details*
4.h. Student Entry/Exit Procedure Followed*
4.h. Non-Compliance Details*
4.i. Monthly Ratio Maintenance Form*
4.i. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
5. Children
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
5.a Personal Hygiene*
5.a. Non-Compliance Details*
5.b. Individual Mat/Bedding Provided*
5.b. Non-Compliance Details*
5.c. Bedding Safe and Sanitary*
5.c. Non-Compliance Details*
5.d. 18-Inches Between Nap Spaces*
5.d. Non-Compliance Details*
5.e. Proper Diaper Changing Area and Storage*
5.e. Non-Compliance Details*
5.f. Change of Clothes*
5.f. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
6. Family and Community Relations
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
6.a. Parent/Student Policy Handbook Provided*
6.a. Non-Compliance Details*
6.b. Health Policy Signed by Parent*
6.b. Non-Compliance Details*
6.c. Discipline Policy Signed by Parent*
6.c. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
7. Health
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
7.a. Adult on Premises with Current First Aid and Infant/Adult CPR*
7.a. Non-Compliance Details*
7.b. First Aid/CPR Handbook Available*
7.b. Non-Compliance Details*
7.c. First Aid Supplies Available*
7.c. Non-Compliance Details*
7.d. Accident/Incident Report Forms Used*
7.d. Non-Compliance Details*
7.e. Procedures Followed for Ill Children*
7.e. Non-Compliance Details*
7.f. Proper Isolation Facilities for Ill Children*
7.f. Non-Compliance Details*
7.g. Medications Stored Properly*
7.g. Non-Compliance Details*
7.h. Universal Body Fluid Precaution Kit*
7.h. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
8. Fire Safety
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
8.a. Working Phone on Premises*
8.a. Non-Compliance Details*
8.b. Certified Fire Alarms or Equivalent*
8.b. Non-Compliance Details*
8.c. Fire Extinguisher Current*
8.c. Non-Compliance Details*
8.d. Fire Exit Signs & Routes Posted in Each Class*
8.d. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
9. Physical Facilities
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
9.a. Buildings Clean*
9.a. Non-Compliance Details*
9.b. Indoor Areas Safe and Sanitary*
9.b. Non-Compliance Details*
9.c. Sufficient Light and Ventilation*
9.c. Non-Compliance Details*
9.d. Room Capacities Posted*
9.d. Non-Compliance Details*
9.e. Dangerous Supplies Stored Properly*
9.e. Non-Compliance Details*
9.f. Outdoor Areas Safe and Fenced*
9.f. Non-Compliance Details*
9.g. Trees Trimmed*
9.g. Non-Compliance Details*
9.h. Fallout Areas Properly Padded*
9.h. Non-Compliance Details*
9.i. Accessible Drinking Water*
9.i. Non-Compliance Details*
9.j. No Firearms on Premises*
9.j. Non-Compliance Details*
9.k. Animal Regulations Followed*
9.k. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
10. Bathroom / Kitchen
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
10.a. Soap and Towels/Dryers Provided*
10.a. Non-Compliance Details*
10.b. Toilet and Sink Accessible to Children*
10.b. Non-Compliance Details*
10.c. Clean and Sanitary/Use of Gloves*
10.c. Non-Compliance Details*
10.d. Hand Washing/Sanitizing Solution*
10.d. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
11. Transportation
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
Is Transportation Provided?*
- Yes
- No
11.a. Drivers Hold Appropriate & Valid Licenses*
11.a. Non-Compliance Details*
11.b. Drivers Have Current First Aid & CPR Training*
11.b. Non-Compliance Details*
11.c. Drivers Physicals on File (Yearly)*
11.c. Non-Compliance Details*
11.d. Child Restraints are Used, Where Applicable*
11.d. Non-Compliance Details*
11.e. Copy of Current Annual Vehicle Inspection in Vehicle*
11.e. Non-Compliance Details*
11.f. Transportation Records Maintained*
11.f. Non-Compliance Details*
11.g. Transportation Procedures in Place*
11.g. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
12. Food Services
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
Is Food Services Provided?*
- Yes
- No
12.a. Appropriate Health Certificate Posted*
12.a. Non-Compliance Details*
12.b. Thermometer in Refrig./Freezer*
12.b. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None
13. Items Displayed In School Office
An item marked COMPLIANT indicates that the center is meeting or exceeding that standard. An item marked NON-COMPLIANT indicates that the center is NOT meeting that standard and requires corrective action within 30 days. Failure to complete corrective action within the allotted time may result in suspension or revocation of certification and notification of status to the local licensing office of the Department of Children and Families and/or Department of Health.
13.a. License Exemption Letter*
13.a. Non-Compliance Details*
13.b. Current FLOCS Certificate*
13.b. Non-Compliance Details*
13.c. Current Fire Inspection*
Date fire inspection EXPIRES:*

Date Format: MM slash DD slash YYYY
13.d. Monthly Fire Drills Recorded and Posted*
13.d. Non-Compliance Details*
13.e. Current Proof of Insurance*
Expiration Date of Certificate of Insurance*

Date Format: MM slash DD slash YYYY
13.f. Copy of Vehicle Inspection, if applicable*
13.f. Non-Compliance Details*
13.g. List of CPR/First Aid Certified Staff*
13.g. Non-Compliance Details*
13.h. Director and Assistant Director's Info*
13.h. Non-Compliance Details*
13.i. Emergency Phone Numbers*
13.i. Non-Compliance Details*
Comments / Feedback:
Please list any comments or feedback you may have concerning this section of the inspection.
None

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Inspection Summary
Below is the summary of your inspection.
Class A Violations*
Class A Violations are 5 points.
Class B Violations*
Class B Violations are 15 points.
Class C Violations
Class Violations are 30 points.
Total Points Assessed*
Total Point Violations
Center Rating
Rating: Excellent
You have received less than 10 points in violations! Congratulations, your center is a School of Excellence. You will receive the SoE seal to be placed on your certificate and a letter of commendation! Keep up the good work!
Rating: Good
15-60 points. No fees will be assessed. Center will be expected to correct the violations within 30 days, showing evidence at the next inspection. An uncorrected violation will receive a Class C status automatically, regardless of what level the violation.
Rating: Fair
65-110 points. A $50 fee will be assessed for an additional inspection. Your center must comply within 30 days. A re-inspection may be required at the end of the 30 day period if information cannot be validated by the FLOCS office.
Rating: Improvements Needed
115-160 points. a $100 fee will be assessed to you school for additional inspections. Your center must comply within 7 days from the date of this inspection. You are subject to a re-inspection within 30 days. You are hereby placed on 90-day probation, and may require an additional inspection at the end of the probation period. Any complaints filed against your center within the probationary period may be grounds for removal.
Rating: Unacceptable

Over 165 points. This report will be submitted to the FLOCS Board of Directors for review. The board will determine probationary status or removal from membership. The boards ruling is final.
Inspector Comments
Inspectors can use this space to make any additional comments on the center.
Inspections Conclusions
Violations must be corrected by:*
Date Format: MM slash DD slash YYYY
Follow up inspection required?*
- N0
- Yes
Fees Assessed
Fees have been assessed to your school due to the number of violations.
Fees Assessed
Fees have been assessed to your school due to the number of violations.
Mileage Paid?*
- No
- Yes
Mileage Amount Received*
Please indicate the amount you received for mileage.
Was this inspection discussed with the director?*
- No
- Yes
Reason for not discussing*
Please indicate the reason for not discussing the inspection with the director.
Name of Director*
Please indicate the name of the director receiving the report.
First Last
Director's Email*
Director Signature*
Director signature below. You may use a touchscreen, touch pad on a laptop, or a mouse to sign this box.
Time Inspection Ended*
Please enter the time you concluded your inspection.

: HH

MM

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Last Name	First Name

Last Name	First Name

Last Name	First Name

Last Name	First Name

Inspection Form

Step 1 of 2 - School Information

1. Governance

2. Curriculum and Instruction

3. Staff

4. Student Admission Policies And Records

5. Children

6. Family and Community Relations

7. Health

8. Fire Safety

9. Physical Facilities

10. Bathroom / Kitchen

11. Transportation

12. Food Services

13. Items Displayed In School Office

Inspection Summary

Center Rating

Rating: Excellent

Rating: Good

Rating: Fair

Rating: Improvements Needed

Rating: Unacceptable

Inspections Conclusions