MARYKNOLL SCHOOL AFTER SCHOOL CARE PROGRAM

HAR §17-896.1-61 — Written evidence of fire warning device or system has been inspected initially and annually and approved by a by fire inspector. Report dated: <date>

Please provide a copy of a satisfactory fire inspection report. Correction: The Worker verified the satisfactory Fire Inspection Report for Maryknoll School After School Care Program by XXXXX, dated 11/26/2025. Refer to the copy on file.

HAR §17-896.1-3 — Background checks according with chapter 17-801 (criminal history, sex offender registry, child abuse/neglect, adult abuse perpetrator, employment history check, and other information)

Please submit a DHS 948 Authorization for Background Check and to Release Findings form for the following staff members, as their clearances are expired: XXXXX. ---------------------------------------------------------- In addition, please submit a DHS 948 Authorization for Background Check and to Release Findings form for the following staff members as well, as there clearances will be expiring soon: XXXXX. ---------------------------------------------------------- *Please use the new DHS 948 form Authorization for Background Check and to Release Findings form with the date of 06/2024. * Visit the following for the required forms: View official inspection document Correction: The Worker received a DHS 948 Authorization for Background Check and to Release Findings form for staff members XXXXX. The Worker also received a DHS 974A Notification of Changes form indicating the termination of staff members XXXXX.

HAR §17-896.1-12 — Evidence of liability coverage

Please submit a copy of your program's current Certificate of Liability Insurance. Correction: The Worker received the Certificate of Liability Insurance for Maryknoll School After School Care Program. Exp. date: 07/01/2026. Refer to the copy on file.

HAR §17-896.1-17 — List of staff members and position

Please submit a DHS 954 Child Care Center Staff and Volunteer Listing and DHS 957 Staff Sequence form. Please visit the following for the DHS required forms: View official inspection document Correction: The Worker received the DHS 954 Child Care Center Staff and Volunteer Listing and DHS 957 Staff Sequence form from the director. Refer to the copy on file.

HAR §17-896.1-35 — All caregivers, substitutes, and volunteers shall complete initial health and safety training within 45 days of hire

Please submit the initial Health & Safety assessments to People Attentive to Children (PATCH) for XXXXX.

HAR §17-896.1-35 — Caregivers shall complete at least 16 hours of ongoing training in at least 2 of the department approved topic areas

Please submit the on-going Health & Safety trainings to People Attentive to Children (PATCH) for XXXXX.

HAR §17-896.1-43 — One caregiver with current pediatric first aid certificate and child CPR during operating hours

Please submit the current Adult and Pediatric First Aid/CPR certificates for the staff members at Maryknoll School After School Care Program. Correction: The Worker received the current Adult and Pediatric First Aid/CPR certificates for 15 of the 25 staff members . All child care hours are covered by staff members who are certified in first aid and child CPR.

HAR §17-896-13 — 25% gross motor activities to promote physical development

The submitted daily schedule of activities shall indicate at least twenty-five percent of the program time is spent in gross motor activities to promote physical activities. Correction: The Worker received the program's daily schedule of activities. The schedule indicates that there are 75 minutes spent in gross motor activities. As the program runs for a total of 210 minutes a day, this verifies that at least twenty-five percent of the program time is spent in gross motor activities to promote physical activities.

HAR §17-896-3 — Employment history check

Please submit the employment history check clearances (DHS 959 Employment History Form and DHS 959A Self-Certification of Employment form) for the following new staff members for the last three (3) years from their date of hire: XXXXX. Employment History Instructions: Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II. Please complete the following information on the form DHS 959A: Date EHC mailed and Date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again in two weeks and log the 2nd date mailed. If forms are not returned after the second try, we will accept the self-certification. Please visit the following for the required forms: View official inspection document Correction: The Worker received the employment history check clearances (DHS 959 Employment History Form and DHS 959A Self-Certification of Employment form) for staff member XXXXX. Also, the Worker received a DHS 974A Notification of Change(s) form for staff member XXXXX, indicating her termination.

HAR §17-896-3 — Child care abuse/neglect check

The child abuse/neglect clearance for XXXXX will be expiring. Please submit a completed DHS 948 Authorization for Background Check and to Release Findings form for XXXXX. Please use the new DHS 948 form with the date of 06/2024. Correction: The Worker received the DHS 948 clearance form for XXXXX.

HAR §17-896-3 — Criminal history check

The criminal history clearance clearance for XXXXX will be expiring. Please submit a completed DHS 948 Authorization for Background Check and to Release Findings form for XXXXX. *Please use the new DHS 948 form with the date of 06/2024. * Correction: The Worker received the DHS 948 clearance form for XXXXX.

HAR §17-896-11 — Daily schedule of activities & menu

Please submit a daily schedule of the after school program's activities, and the program's P.M snack menu. Correction: The Worker received the program's daily schedule of activities and P.M snack menu. Refer to the copies on file.

HAR §17-896-18 — Health consultation provisions

Please provide a written agreement with a physician or public health nurse, who has agreed to be your program's health consultant. Correction: The CCL Worker received a letter from XXXXX, stating that he will serve as the health consultant for Maryknoll School. Refer to the copy on file.

HAR §17-896-29 — Plan practiced at regular intervals

Please submit a fire drill log, which shows that drills are being conducted at regular intervals. Correction: The Worker received the program's fire drill log, and verified that the drills are being conducted at regular intervals (once a month). Refer to the copy on file.