After-School Program Licensing Compliance Checklist Form

After-School Program Licensing Compliance Checklist Form
Complete this checklist to ensure your after-school program meets all licensing requirements. Please provide accurate information and supporting documentation for compliance verification.
Program Name
Program Director / Contact Name
First NameLast Name
Facility Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Licensing Region / Jurisdiction
Program Age Group Served
Other
Checklist of Compliance Areas Covered

Current Compliance Status for Each Checklist Item

Rows	Compliant	Non-Compliant	Not Applicable
Staff Qualifications & Background Checks
Staff-to-Child Ratios & Supervision
Facility Health & Safety Standards
Emergency Preparedness & Response Plans
Child Enrollment & Attendance Records
Nutrition & Food Service Compliance
Transportation Policies (if applicable)
Medication Administration Protocols
Parent/Guardian Communication Procedures
Inclusion & Non-Discrimination Policies

Required Documentation Attached
Cancelof
Planned Follow-Up / Correction Deadline
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional Notes / Corrective Actions
Should be Empty:

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