Quality Standard Facilitator Questionnaire Quality Standard Facilitator Questionnaire Site: Date:Facilitators Name:Facilitators will need the following: Afterschool Safety Plan Parent Sign out sheet Copy of the site behavior process Schedules and lesson plans for each of your staff for the day Any positive behavior support plans with the student names redacted (blacked out) Student accident report with names redacted (blacked out) Injury communication log with names redacted (blacked out) Question Title * 1. Name Question Title * 2. Is the Afterschool ERCM Team Members form filled out? Yes - Completed filled in No - Not filled in Incomplete Question Title * 3. Is the Afterschool Safety plan signed by the administrator and facilitator? Yes NO Question Title * 4. Is the on and off campus point of evacuation location filled out (it is located under Emergency Action 2) Yes No Question Title * 5. On the Afterschool program drill schedule, procedures and report, are the actual drill dates and drill times up to date? Actual Drill Dates are filled in Drill Time is completed Both areas are not up to date Question Title * 6. Does the site have any students that require a modification of an activity? Question Title * 7. Does that site have any students with special medical needs? (Epi Pens, inhalers, etc.)Please give their initials and type of need. Example EY asthma needs inhaler Question Title * 8. Have your parents received a copy of you parent handbook? All parents have recieved Some parents have recieved Parents have not received Question Title * 9. Where are your parent handbook located? Question Title * 10. Does the site have a Afterschool site behavior process? Yes,all staff are aware of the process Yes, but all staff are not aware No Question Title * 11. On the schedules, are location and/or room numbers are listed for: All Activities Most Activities Some Actiivities No Activities Question Title * 12. What has the site done to connect families to resources and community services? Question Title * 13. In reviewing the positive behavior support plan It is evident that: (Select all that apply) Staff is involved in the process Parent and student is involved in the process School site is involved in the process Could not tell who was involved in the process The site has not done a positive behavior support plan for a student Question Title * 14. Are staff held accountable for their role as it pertains to their job description? Always Sometimes Never Question Title * 15. Are staff trained in policies and procedures that affect the day to day operations of the afterschool program? (snack, attendance, & sign out process, time requirements etc. ) Staff is well trained Staff has limited training Staff lacks appropriate training Question Title * 16. Are staff able to articulate policies and support grant compliance? Yes Somewhat No Not Sure Question Title * 17. What do you do to help support staff in core academic areas? (Math and ELA) Question Title * 18. When are schedules and lesson plans due? Question Title * 19. When are schedules to be posted? Question Title * 20. Does the site document injuries and phone contact with parents? (Injury Communication Log) Yes No Question Title * 21. Are parent notified in a timely manner regarding injuries? Yes No Question Title * 22. Are student accident forms completed in a timely manner? Yes No Done