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Get Indian Health Service Head Start Checklist Form

HEAD START FACILITY SURVEY CHECKLIST MODEL TRIBAL HEAD START HEALTH AND SAFETY CODE February 2001 Facility w/ Permit if Applicable Staff Employed FDS Children Enrolled Name of Facility Supervisor Mailing Address Telephone City/State/Zip Fax Survey Date Building Owner Tribal State Fed Classroom Space Avail. ft 2 Surveyed by Year Constructed Building Type stick built modular trailer All Code s marked with an asterisk and in bold are critical and s.

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