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Licensing Forms for Residential and Placement Programs

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Residential and Placement Required Forms

Open PDF file, 11.15 KB,  Fire Inspection Report (English, PDF 11.15 KB)
Open PDF file, 21.69 KB,  Guidelines for Refresher Restraint Curricula (English, PDF 21.69 KB)
Open PDF file, 22.25 KB,  Guidelines for Restraint Curricula (English, PDF 22.25 KB)
Open PDF file, 37.88 KB,  Guidelines for Restraint Curricula Checklist (English, PDF 37.88 KB)
Open PDF file, 36.03 KB,  Guidelines for Restraint Policy (English, PDF 36.03 KB)
Open PDF file, 15.31 KB,  Health Inspection Report (English, PDF 15.31 KB)
Open PDF file, 15.64 KB,  Procedures for Completing Residential Care Records Checklists (English, PDF 15.64 KB)
Open PDF file, 27.84 KB,  Residential Care and Placement Programs Personnel Checklist (English, PDF 27.84 KB)
Open PDF file, 561.79 KB,  Residential Care Children's Record Checklist (English, PDF 561.79 KB)
Open PDF file, 14.25 KB,  Sample Physical Restraint Incident Report (English, PDF 14.25 KB)
Open PDF file, 40.46 KB,  Shelter Parent Record Checklist (English, PDF 40.46 KB)

Residential Facility Safety and Maintenance Checklist

Residential programs must complete a Facility Safety and Maintenance Checklist monthly and make it available to EEC upon request.

Open DOCX file, 330.4 KB,  Residential Facility Safety and Maintenance Checklist - MS Word Template (English, DOCX 330.4 KB)
Open PDF file, 320.37 KB,  Residential Facility Safety and Maintenance Checklist - PDF for Printing (English, PDF 320.37 KB)

Sample Forms to Help You Operate Your Residential or Placement Program

Open PDF file, 21.82 KB,  51A or Incident Reporting Checklist for Foster Care Programs (English, PDF 21.82 KB)
Open PDF file, 18.33 KB,  Incident Checklist for Residential & Placement Program (English, PDF 18.33 KB)

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