Library: Policy

340:110-1-4.1. Forms [Revoked 1-1-16]

[Revoked 1-1-16]

Forms that apply to this Part are described in this Section.

(1) 07LC002T, Staff Summary. Form 07LC002T is used to document compliance with licensing requirements for all staff currently employed by the child care facility.
(2) 07LC003E, Monitoring Report - Child Care Center. Form 07LC003E is used by licensing staff to document compliance with requirements during a monitoring visit at a child care center and record any other information obtained.
(3) 07LC004E, Request for License - Child Care Facility. Form 07LC004E is used to request a license to operate a child care facility, including a child care center, school-age program, and part-day children's program.
(4) 07LC005E, Transportation Information. Form 07LC005E is used by a child care facility director to document compliance with licensing requirements on transportation.
(5) 07LC006E, Equipment Inventory - Child Care Center. Form 07LC006E is used to document the equipment available and items needed to comply with OKDHS Publication no. 84-08, Licensing Requirements for Child Care Centers.
(6) 07LC007E, Training Documentation. Form 07LC007E is used by child care facilities to document annual training of staff.
(7) 07LC008E, Periodic Monitoring Report - Certification for Care of Children with Disabilities. Form 07LC008E is used by licensing staff to document ongoing compliance with certification requirements during monitoring visits.
(8) 07LC010E, Monitoring Report - Part-Day Children's Program. Form 07LC010E is used by licensing staff to document compliance with licensing requirements during a monitoring visit at a part-day children's program and to record any other information obtained.
(9) 07LC012E, Licensing Complaint. Form 07LC012E is used to record a complaint against a child care facility.
(10) 07LC014E, Monitoring Report - Family Child Care Home. Form 07LC014E is used to document compliance with requirements during a monitoring visit to a family child care home and record other information obtained.
(11) 07LC020E, Equipment Inventory - Part-Day Children's Program. Form 07LC020E is used to document the equipment available or needed to comply with Licensing Requirements for Part-Day Children's Programs, no. 95-12, OKDHS Publication.
(12) 07LC021E, Comments and Recommendations Regarding Licensing Requirements. Form 07LC021E is used to make comments and recommendations pertaining to licensing requirements and policy.
(13) 07LC023E, Monitoring Report - School-Age Program. Form 07LC023E is used to document compliance with licensing requirements for school‑age programs during a monitoring visit and record any other information obtained.
(14) 07LC024E, Equipment Inventory - School-Age Program. Form 07LC024E is used to document the equipment available or needed to comply with Licensing Requirements for School-Age Programs, no. 97-10, OKDHS Publication.
(15) 07LC025E, Request for Child Care Center Star Certification. Form 07LC025E is used by a child care center owner or director to request star certification.
(16) 07LC026E, Child Care Center Star Certification Review. Form 07LC026E is used to document compliance with criteria for star certification and to establish a plan to correct violations in a child care center.
(17) 07LC027E, Request for Family Child Care Home Star Certification. Form 07LC027E is used by a family child care home provider to request star certification.
(18) 07LC028E, Family Child Care Home Star Certification Review. Form 07LC028E is used to document ongoing compliance with criteria for star certification and to establish a plan to correct violations in a family child care home.
(19) 07LC037E, Notice to Comply. Form 07LC037E is used by a child care facility to document required plans of correction.
(20) 07LC038E, Child Information. Form 07LC038E is used by the child care facility to record enrollment information for a child.
(21) 07LC041E, Staff Information – Child Care Facility. Form 07LC041E is used to record information regarding child care facility staff persons as required by licensing requirements.
(22) 07LC042E, Request for License – Family Child Care Home and Large Child Care Home. Form 07LC042E is used to make application for license to operate a family child care home or large child care home.
(23) 07LC057E, Physical Plant. Form 07LC057E is used by licensing staff to document the floor plan, including indoor and outdoor square footage and numbers of toilets and sinks.
(24) 07LC061E, Alternative Compliance Request. Form 07LC061E is used by a child care facility to request an alternative method of complying with licensing requirements.
(25) 07LC068E, Licensing Specialist Training Checklist. Form 07LC068E is used by licensing staff to ensure completion of all training requirements, per policy, for new licensing specialists.
(26) 07LC069E, Compliance Review for Child Care Centers. Form 07LC069E is used by child care center directors to verify their knowledge of the licensing requirements.
(27) 07LC070E, Fire Safety Inspection Report for Child Care. Form 07LC070E is used by fire officials for inspection of facilities.
(28) 07LC071E, Licensing Services Waiver Referral. Form 07LC071E is used by licensing staff when submitting a waiver request to State Office.
(29) 07LC072E, Compliance Review for School-Age Programs and Summer Day Camps. Form 07LC072E is used by school-age and summer day camp directors to verify their knowledge of the licensing requirements.
(30) 07LC073E, Compliance Review for Part-Day Children's Programs. Form 07LC073E is used by part-day children's program directors to verify their knowledge of the licensing requirements.
(31) 07LC074E, Request for Extension of Time to Comply. Form 07LC074E is used by child care providers to request an extension of time to comply with Stars criteria.
(32) 07LC075E, Notice of Alternative Compliance. Form 07LC075E is used by licensing staff to notify a facility of an approved request for alternative method of compliance.
(33) 07LC079E, Child Death Report. Form 07LC079E is used by licensing staff in the event of a child death in a child care facility.
(34) 07LC080E, Licensing Services Supplemental Information. Form 07LC080E is used to provide supplemental facility information.
(35) 07LC081E, Licensing Complaint Report Summary. Form 07LC081E is placed in the case record and includes the findings of an investigation in compliance with Section 406 of Title 10 of the Oklahoma Statutes.
(36) 07LC084E, Notice to Parents. Form 07LC084E is posted in child care facilities to inform parents of the requirements for licensing compliance posting and the licensing compliance file.
(37) 07LC085E, Notice of Voluntary Cease Care. Form 07LC085E is used to verify with facilities their agreement to voluntary cease care.
(38) 07LC086E, Staff Information - Family Child Care Home. Form 07LC086E is used to record information regarding family child care home staff persons as required by licensing requirements.
(39) 07LC087E, Waiver Notification. Form 07LC087E is used to inform facilities of a decision regarding a waiver request.
(40) 07LC088E, Notice of Emergency Order. Form 07LC088E is used to notify parents of an immediate closure of their child care facility.
(41) 07LC089E, Child Care Waiver Request. Form 07LC89E is used by a program director to request a waiver for a person with a restricted criminal history.
(42) 07LC090E, Waiver Reference. Form 07LC090E is used to obtain references for a person with a restricted criminal history.
(43) 07LC091E, Change of Ownership. Form 07LC091E is used by current and prospective owners of facilities to notify licensing of ownership changes.
(44) 07LC092E, Insurance Verification. Form 07LC092E is completed annually to verify liability insurance coverage.
(45) 07LC093E, Insurance Exception Notification. Form 07LC093E is completed and posted at the facility to notify parents that liability insurance coverage is not provided or facility reports they are self-insured.
(46) 07LC095E, Notice Regarding Unlicensed Care. Form 07LC095E is provided to facilities during the investigation of unlicensed care.
(47) 07LC096E, Criminal History Review Request. Form 07LC096E is completed by facilities to request a criminal history review by licensing records office.
(48) 07LC097E, Citation Request. Form 07LC097E is used when requesting assistance of Council on Law Enforcement Education and Training (CLEET)-certified officers.
(49) 07LC098E, District Attorney Referral. Form 07LC098E is used when requesting a district attorney file criminal charges and/or issue an injunction.
(50) 07LC099E, Dual Approval Request for Kinship Placement in a Licensed Family Child Care Home. Form 07LC099E is used for approving acceptance of a foster care placement in a family child care home.
(51) 07LC100E, Emergency Order Request. Form 07LC100E is used by licensing specialist and supervisor when requesting an emergency order.
(52) 07LC101E, Restricted Registry Verification. Form 07LC101E is used by child care facilities and licensing to verify non-registration and registration of individuals recorded on the Child Care Restricted Registry.
(53) 07LC102E, Restricted Registry Notification. Form 07LC102E is used by the licensing records office to notify individuals of potential registration on the Child Care Restricted Registry.
(54) 07LC103E, Restricted Registry Final Notification. Form 07LC103E is used by licensing records office to notify individuals of registration on the Child Care Restricted Registry.
(55) 07LC104E, Restricted Registry Notification to Child Care Facility. Form 07LC104E is used by the licensing records office to notify child care facilities of individuals registered on the Child Care Restricted Registry.
(56) Form 07LC105E, Alternative Compliance Referral. Form 07LC105E, is used by licensing staff to refer an alternative compliance request to State Office personnel.
(57) Form 07LC106E, Criminal History Review Results. Form 07LC106E is used to notify facilities of the results of the criminal history review.
(58) Form 07LC107E, Child Care Restricted Registry Notice. Form 07LC107E is used as additional notification to facility employees and residents of the Child Care Restricted Registry registration process.