Child Care Facility Title 19 Compliance Inspection Checklist Form
Use this form to document the results of a Title 19 compliance inspection for a child care facility. Complete all sections to ensure a thorough review.
Facility Name
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Safety and Security Compliance
*
Compliant
Non-Compliant
Not Applicable
Records and Documentation Compliance
*
Compliant
Non-Compliant
Not Applicable
Staff-to-Child Ratio Compliance
*
Compliant
Non-Compliant
Not Applicable
Emergency Procedures Compliance
*
Compliant
Non-Compliant
Not Applicable
Physical Environment Compliance
*
Compliant
Non-Compliant
Not Applicable
Findings/Comments
Corrective Actions and Follow-Up Timing
Submit Inspection
Should be Empty: