Form LIC 9213 at a glance
What it is: Form LIC 9213 is the Notice of Site Visit by a Child Care Licensing Office Representative.
A filled-in Form LIC 9213 example: a site visit with a Type B violation

How to fill out Form LIC 9213, box by box
Name of Facility, License Number and Date of Visit
Regulatory violations issued during this visit
Type A violations
Type B violations

If regulatory violations were cited, mark Yes or No: could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.
Posting the notice and the Regional Office Contact Person

Only visit reports documenting Type A violations and corrections of violations must be posted in the child care facility for 30 consecutive days.
This notice must be posted for 30 days.
Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office.
Enter the Regional Office Contact Person and the Contact Person Telephone Number.
Sources
[1] Form LIC 9213 (1/04), Notice of Site Visit by a Child Care Licensing Office Representative, California Department of Social Services (the Official source link on this page).



