The Lic 610 form is an important document for businesses in California. This form is used to apply for a license to conduct business in the state. The process of obtaining a business license can be complex, so it is important to understand the requirements and procedures involved. By Famly Law Firm. 2 years ago from FamlyLawFirm's Blog. Licensed by CC BY-NC-ND 4.0) The Lic 610 form is an important document for businesses in California. This form is used to apply for a license to conduct business in the state. The process of obtaining a business license can be complex, so it is important to understand the requirements and procedures involved.
Before you fill out lic 610 form, you will want to know more concerning the type of form you'll work with.
| Question | Answer |
|---|---|
| Form Name | Lic 610 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | lic 610 emergency disaster plan, emergency disaster form, 610 form, lic 610 form |
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY |
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES |
EMERGENCY DISASTER PLAN FOR CHILD CARE CENTERS
INSTRUCTIONS:
Post a copy in a prominent location in facility, near telephone.
Licensee is responsible for updating information as required. Return a copy to the licensing office.
NAME OF FACILITY
ADMINISTRATOR OF FACILITY
FACILITY ADDRESS (NUMBER, STREET, |
CITY, |
STATE, |
ZIP CODE) |
TELEPHONE NUMBER
( )
I.ASSIGNMENTS DURING AN EMERGENCY (USE REVERSE SIDE IF ADDITIONAL SPACE IS REQUIRED)
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NAME(S) OF STAFF |
TITLE |
ASSIGNMENT |
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1. |
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DIRECT EVACUATION AND PERSON COUNT |
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2. |
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HANDLE FIRST AID |
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3. |
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TELEPHONE EMERGENCY NUMBERS |
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4. |
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TRANSPORTATION |
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5. |
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OTHER (DESCRIBE) |
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6.
II.EMERGENCY NAMES AND TELEPHONE NUMBERS (IN ADDITION TO
POLICE OR SHERIFF
OFFICE OF EMERGENCY SERVICES
RED CROSS
POISON CONTROL
HOSPITAL(S)
OTHER AGENCY/PERSON
CHILD PROTECTIVE SERVICES
III. FACILITY EXIT LOCATIONS (USING A COPY OF THE FACILITY SKETCH [LIC 999] INDICATE EXITS BY NUMBER)
1.
3.
2.
4.
IV. TEMPORARY RELOCATION SITE(S) (IF AVAILABLE, SUBMIT LETTER OF PERMISSION FROM RENTER/LEASSOR/MANAGER/PROPERTY OWNER)
NAME |
ADDRESS |
TELEPHONE NUMBER |
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( |
) |
NAME |
ADDRESS |
TELEPHONE NUMBER |
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( |
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V.UTILITY
ELECTRICITY
WATER
GAS
VI. FIRST AID KIT (LOCATION)
VII. EQUIPMENT
SMOKE DETECTOR LOCATION (IF REQUIRED)
FIRE EXTINGUISHER LOCATION (IF REQUIRED)
TYPE OF FIRE ALARM SOUNDING DEVICE (IF REQUIRED)
LOCATION OF DEVICE
VIII. AFFIRMATION STATEMENT
AS ADMINISTRATOR OF THIS FACILITY, I ASSUME RESPONSIBILITY FOR THIS PLAN FOR PROVIDING EMERGENCY SERVICES AS INDICATED BELOW. I SHALL INSTRUCT ALL CLIENTS/RESIDENTS, AGE AND ABILITIES PERMITTING, ANY STAFF AND/OR HOUSEHOLD MEMBERS AS NEEDED IN THEIR DUTIES AND RESPONSIBILITIES UNDER THIS PLAN.
SIGNATURE
DATE
LIC 610 (10/03) (PUBLIC)