
Ng evaluator and reviewed by the licensing supervisor. The purpose of this form is to review staff coverage in large Residential Facilities for 24-hours per day covering a (3) three-week period to ensure sufficient staff coverage. CAREFULLY review split shifts, weekend coverage and irregular days off to ensure sufficient staff coverage. FACILITY NAME FACILITY NUMBER CLIENT/RESIDENT CENSUS LICENSING EVALUATOR For The Month(s) 2. Food Services (e.g, includes cook, dishwasher) Employee Name(s.
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How to fill out the Lic 507 online
The Lic 507 form is essential for evaluating staff coverage in large residential facilities. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently online.
Follow the steps to complete the Lic 507 form successfully.
- Press the ‘Get Form’ button to access the Lic 507 and open it in your chosen editor.
- Begin by entering the facility name and facility number at the top of the form. Ensure that this information is accurate to avoid any processing delays.
- Next, fill in the client or resident census, which indicates the number of individuals being served in the facility.
- Identify the licensing evaluator responsible for completing the form and enter their name in the designated field.
- In the section for food services, list the names of employees responsible for this area, such as cooks and dishwashers. Then, input their work hours for each day of the week.
- Continue with the care and supervision section by adding employee names and their work hours in a similar manner, ensuring you account for all relevant staff.
- Proceed to the housekeeping section by entering staff names and their work hours. Repeat this process for any additional service areas, such as transportation/maintenance and administrative/clerical staff.
- Lastly, review all entries to confirm that the information is complete and accurate before submitting. Once satisfied, you can save changes, download, print, or share the completed Lic 507 form.
Complete the necessary documents online to ensure compliance and proper staffing for your facility.
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