Dss Form 2905 PDF Details

Ensuring the safety and well-being of children in care facilities is a paramount concern for society, requiring rigorous standards and regular inspections. In South Carolina, the Department of Social Services Child Care Licensing plays a crucial role in this process through the DSS 2905 form, a document that facilitates the DHEC-Fire Inspection Request for Child Care Facilities. This form, to be filled out comprehensively by the facility's Director or Operator, serves as a formal request for a fire or sanitation inspection, critical for both new and renewal applications of various types of childcare establishments, including child care centers, group homes, faith-based, and family care homes. With an inspection fee of $60, payable to DHEC, the form outlines necessary information such as the facility's operational details, contact information, and directions to the location especially in cases of remote or hard-to-find venues. It also specifies the method of payment for the DHEC inspection, aiming to streamline the inspection request process. The benefit of such an organized approach ensures that all childcare facilities adhere to essential health and safety standards, fostering a safe environment for children's growth and development.

QuestionAnswer
Form NameDss Form 2905
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesOCT, dhec, APPLICANTS, South_Carolina

Form Preview Example

South Carolina Department of Social Services

Child Care Licensing

DHEC-FIRE INSPECTION REQUEST: CHILD CARE FACILITY

To be completed in full by the Director/Operator and returned with a check or money order in the amount of $60.00 payable to DHEC. Mail check and form to your DSS Child Care Licensing Regional Office OR submit payment online at childcare.sc.govand mail this form to your DSS Child Care Licensing Regional Office.

Type of Inspection Requested: n DHEC Sanitation Inspection (New and renewal applications)

n Fire Inspection (New applications only – renewal requests are generated automatically)

Type of Facility: n Child Care Center (13 or more children)

n Group Child Care Home

 

 

 

 

 

n Faith-Based Facility

 

 

n Family Child Care Home

 

 

Facility Name:

 

 

 

 

 

County:

 

 

 

Days of Operation: (Check all that apply) n Mon.

n Tues.

n Wed.

n Thur.

n Fri. n Sat.

n Sun.

Facility Address:

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

Zip:

 

 

 

 

Telephone: (

 

)

 

Mailing Address: (If different from above)

 

 

 

 

 

 

 

 

 

 

 

 

Name of Director/Operator:

 

 

 

 

 

Hours of Operation:

 

 

 

 

Overnight care provided? (Care provided anytime between 1:00 AM and 5:00 AM) n Yes

 

n No

 

 

Name and Telephone Number of Facility Contact Person:

 

 

 

 

 

 

 

 

 

n Director n Operator n Sponsoring Agency Rep.

n Owner

n Buyer

 

n Other

 

 

List ALL buildings or portables in Licensed/Registered facilities and ALL rooms used for child care in public schools:

n Payment for DHEC inspection was submitted online.

Date of Online Payment:

 

 

/

 

 

 

/

 

 

 

 

 

 

 

 

Payment Type: n Credit Card n Debit Card n Electronic Check

Payment Reference No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Director/Operator:

 

 

 

 

Date:

 

 

 

 

 

FOR NEW APPLICANTS ONLY

Directions to Facility: (Include specific details indicating nearby landmarks when facilities are in isolated rural areas or other hard to find locations. Use back of form if necessary.)

DSS USE ONLY – Complete and send to DHEC

Please check type of inspection requested:

n New Application n New Construction n Renovation

n Renewal

 

 

 

 

 

 

 

 

 

 

 

Expiration Date

Please mail Inspection Report to the attention of

 

 

 

 

 

at the address shown below:

 

 

DSS Child Care Licensing Specialist

Online Payment Verified by:

 

 

 

 

Date Mailed to DHEC:

 

 

Authorized DSS Staff Member

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DSS Form 2905 (JUN 12) Edition of MAR 12 is obsolete.

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Authorized DSS Staff Member, Online Payment Verified by, and Signature of DirectorOperator in dhec

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