SC DSS Form 2964 PDF Details

The South Carolina Department of Social Services (SC DSS) plays a critical role in ensuring the safety and well-being of children in child care facilities. One of the key tools it uses to achieve this goal is the SC DSS 2964 form. This comprehensive document is designed for use by child care facility operators, encompassing a checklist that details vital information about current staff and caregivers. The form requires information such as the names of all personnel, their positions, dates of birth, social security numbers, employment dates, the number of days and hours they are on duty, the primary age group they are assigned to, their years of experience, and their educational levels. Additionally, it mandates that operators verify critical data, including CPR and First Aid certifications, TB test results, SLED (South Carolina Law Enforcement Division) results, and fingerprinting, to ensure that all staff members are qualified and safe to be around children. The form also includes sections on whether certain policies have been covered, if bloodborne pathogens (BBP) training has been conducted, and a comprehensive outline of the staff's training records. Designed to be maintained in the employee's file by the child care facility, the SC DSS 2964 form acts as a detailed record to aid in the supervision by the Department of Social Services' Child Care Licensing and Regulatory Services. By outlining the necessary documentation and verification of staff members' qualifications and backgrounds, this form plays a pivotal role in maintaining the standards of care for South Carolina's youngest citizens.

QuestionAnswer
Form Name SC DSS Form 2964
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names dss form 2963, sc dss form 2964, Licensing, DSS

Form Preview Example

License/Registration/Approval No.:

South Carolina Department of Social Services

Child Care Licensing and Regulatory Services

SECTION 3: CURRENT CHILD CARE FACILITY STAFF/CAREGIVER CHECKLIST

Name of Facility:

 

County:

To be completed by the child care facility operator – include emergency personnel

Date:

For DSS Child Care Licensing Only

To Be

Name

Position

Date of Birth Social Security Number

Employment Start Date

Employment End Date

Days/

Hours on

Duty

Example:

M-F/8-5

Primary Age Group Assigned

Years of Experiences

Collected/

 

 

 

 

 

 

 

 

 

 

 

Verified by

 

To Be Maintained in Employee File

Licensing

 

 

 

 

 

 

 

 

 

 

 

Specialist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ed. Level Verified*

CPR Infant/Child

First Aid

DSS Form 2901

 

DSS Form 2924

DSS Form 2925

DSS Form 2926

TB Test

SLED Results

Fingerprint Results

All Policies

BBP Training

Training Record

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Staff:

 

(Page

 

of

 

)

*Verify educational level by listing the diploma or degree

Use additional pages if necessary

DSS Form 2964 (MAR 10) Edition of MAR 94 is obsolete.

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Step # 1 in completing 2964 sc dss

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