Quality Standard Facilitator Questionnaire Survey

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)

1.Name

2.Is the Afterschool ERCM Team Members form filled out?

Yes - Completed filled in

No - Not filled in

Incomplete

3.Is the Afterschool Safety plan signed by the administrator and facilitator?

Yes

4.Is the on and off campus point of evacuation location filled out (it is located under Emergency Action 2)

Yes

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

6.Does the site have any students that require a modification of an activity?

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

8.Have your parents received a copy of you parent handbook?

All parents have recieved

Some parents have recieved

Parents have not received

9.Where are your parent handbook located?

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

11.On the schedules, are location and/or room numbers are listed for:

All Activities

Most Activities

Some Actiivities

No Activities

12.What has the site done to connect families to resources and community services?

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

14.Are staff held accountable for their role as it pertains to their job description?

Always

Sometimes

Never

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

16.Are staff able to articulate policies and support grant compliance?

Yes

Somewhat

Not Sure

17.What do you do to help support staff in core academic areas? (Math and ELA)

18.When are schedules and lesson plans due?

19.When are schedules to be posted?

20.Does the site document injuries and phone contact with parents? (Injury Communication Log)

Yes

21.Are parent notified in a timely manner regarding injuries?

Yes

22.Are student accident forms completed in a timely manner?

Yes