MARYLAND STATE DEPARTMENT OF EDUCATION – Office of Child Care – Licensing
LETTER OF COMPLIANCE INSPECTION REPORT
NURSERY SCHOOL: Y N TIER_____ ACCREDITED: Y N ACCREDITING ORGANIZATION: ________________________________________ EXP. DATE: _______/_______/_______ Mo. Day Year WORKER’S COMPENSATION INSURANCE COVERAGE: Y N EXP. DATE: _______/_______/_______ Mo. Day Year OPERATOR NAME:JURISDICTION:REGION:FACILITY NAME:LETTER OF COMPLIANCE #: ADDRESS:INSPECTION DATE/TIME:PERSON(S) INTERVIEWED:TELEPHONE:E-MAIL:TITLE(S):
PART 1 - MANDATORY REVIEW ITEMS
INSTRUCTIONS: (1) Review each regulation that applies to the inspection being conducted.(2) The compliance status of an item listed under Part 2 may be recorded when deemed necessary.(3) Initial/Resumption/Conversion/Full Inspection - Complete both Part 1 and Part 2.
Notification of New Employee____
Appropriate Supervision ____.
Group Size and Staffing
Appropriate Facilities and Supplies____
Emergency Escape Route Posted
General Cleanliness and Disposal of Refuse
Emergency Contact Posted
Outdoor Activity Area____
Safe Use of Materials and Equipment ____.
Abuse and Neglect Reporting____
Potentially Hazardous Items
Approved Capacity:________ AGES
Approvedfor # Enrolled# Present
2’s3’s4’s5’s (pre-school)5-15 (school-age)
Initial ApplicationConversionMandatory ReviewFullComplaint InvestigationMonitoringOther
CDNXNA-----In ComplianceDiscussedNot in ComplianceNot InspectedNot Applicable