Developmental Home Provider Hiring Checklist Form printable pdf download

Developmental Home Provider Hiring Checklist

Name of Developmental Home Provider __________________________________Client:

Request for

Consideration** (If not already filled out)

Screen/Interview prospective contractors

Get $$ Money Offer from Marilyn and complete all section highlighted in yellow.

Have prospective contractor and all individuals within the home fill out background check forms

** include printed

email response notifying you of background check clearance

State of Vermont Pre-Service Training certificate – Prior to any support/service to client. Include copy of certificate

Confidentiality

Policy**

Peggy’s Law

Disclosure**

Consumer File Update

Form** Address section must be completed

DH Contact Information

Form**

Review DH information

packet** return documentation of review

Review HIPAA Booklet –

return documentation of review

Arrange move – Date of occupancy

Set up Housing Inspection – Inspection Date:

Special Care Procedures with Scott – Appointment date:

Provide documentation

Schedule Orientation – Training Date:

Schedule NCI or Therapeutic Options – Training Date:

Schedule CPR/First Aid/AED – Training Date:

Sign Contract – A copy of the DH’s declaration page for Home Owners and Auto Insurance policies is required*. The

contractor shall maintain homeowner’s or renter’s insurance on the premises where the consumer is residing with

liability coverage covering the contractor against claims for bodily injury, death and property damage to others of not

less than $300,000. The contractor shall maintain automobile liability insurance with minimum limits of $300,000 for

any vehicle used to transport the consumer.

Contract Signing Checklist

**Attach all forms and deliver entire packet to Fawn

Every box must be checked and every training scheduled – Provide documentation for each training. It is the Service

Coordinator’s responsibility to follow up on attendance.

Service Coordinator Signature ______________________________Date____________________

Supervisor/Program Manager Signature _______________________Date____________________

Developmental Home Provider Hiring Checklist Form