CCL-205 Staff Non Staff Record Summary Excel May 2021.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L	M
1	CCL-205				Staff/Non-Staff Record Summary
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3	Director Name:						Facility Name:					Certificate Number:
4	Insturctions:
5	* List all individuals working at the facility including: staff, substitutes, volunteers, janitors, cooks, bus drivers, secretaries, speech therapist, occupational therapist, social/family aides, etc. (Section 1 and Section 2)
6	* For FCCHs and FCCCs that are in a residence, all household members example Spouse, Adult Child, Relative, Friend, etc. age 18 years and older must also be listed, even if not present when children are in care (Section 1)
7	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
8	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1. CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELS	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
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14	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
15	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1. CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELG and ELF Date	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
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24	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
25	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1. CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELG and ELF Date	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
26	1. 2. 3.									1. 2. 3. 4.
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34	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
35	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1. CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELG and ELF Date	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
36	1. 2. 3.									1. 2. 3. 4.
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44	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
45	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1. CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELG and ELF Date	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
46	1. 2. 3.									1. 2. 3. 4.
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54	Section 1: Required for all							Section 2 Required for individuals providng direct care to children
55	1. Name 2. Date of Birth 3. Position or Job Title: example Assistant Director, Infant Director	Start Date or Date Moved into the Home	Central Registry Check Date and Results Passed yes or no	Out-of- State Abuse Neglect Check Date and Results Passed yes or no	Sex Offender Check Date and Results Passed yes or no	DCI/FBI Fingerprint Check Date and Results Passed yes or no	Risk Assessment yes or no OR TB Test Date and Results Positive or Negative	Used to meet Saff:Child ratios or direct care of children yes or no	Used 24 Hours or More per month in direct care of children yes or no	1 .CCL Rules Date 2. Facility Staff Orientation Date 3. Pre-Service Date 4.ELG and ELF Date	Infant/CPR Expires Date First Aid Expires Date	Works with nfants yes or no	Transports Children yes or no Driver's License expiration date
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