School-AgeCare (SAC)Program
Documentation List
Revised as of March 2016
Program Name: ______Building #: ______
Current Capacity: _____Current Enrollment: _____
The following documentation will be reviewed as evidence of compliance with the SAC Program Inspection Criteria revised as of March 2016. Items 1-25are maintained in files. Note: If the SAC Program is
co-located with Youth Programs (YP), omit the following files: 11, 15-20, the visitor’s log, and the daily inspections; these files will be inspected under YP. Ensure the files are standardized and organized according to the listing below. Only include documentation from the previous 12 months unless otherwise indicated below. In addition to these files, the inspector(s) will review selected forms, youth files, work folders, and training files. Documents with Personally Identifiable Information (PII) will be gathered during the inspection.
Tab / Criterion / Documentation Needed1 / S3 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S3 after each activity which supports developmentally appropriate opportunities to foster a positive self-concept.
develop independence and demonstrate self-help skills
respond to individual differences in abilities and interests
demonstrate respect and value for each youth
other
2 / S4 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S4 after each activity which supports developmentally appropriate opportunities to develop and enhance social skills that support positive peer interactions.
support resistance from peer pressure
offer a wide range of recreational activities
other
3 / S5 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S5 after each activity which supports developmentally appropriate opportunities to encourage thinking, reasoning, questioning, and experimentation that supports academic success.
develop an understanding of numbers, number names, the relationship to object
quantities, and symbols
expose science, technology, engineering, and mathematics (STEM) concepts
other
4 / S6 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S6 after each activity which supports developmentally appropriate opportunities to encourage appreciation of art, music, drama, and dance in ways that reflect cultural diversity.
create their own music
involve music, movement, and singing
develop an appreciation for the arts by taking trips on or off the installation
(e.g., to historical sites, museums, monuments, galleries, concerts,etc.)
perform (e.g., exhibits, talent shows, poetry reading, etc.)
other
5 / S7 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S7 after each activity which supports developmentally appropriate opportunities to enhance physical development.
enhance fine motor skills
offer large motor skills
other
6 / S8 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S8 after each activity which supports developmentally appropriate opportunities to help youth develop a respect for ethnic and cultural diversity.
expose youth to different cultures
have youth and their families share their home culture and language
other
7 / S9 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S9 after each activity which supports developmentally appropriate opportunities that provide hands-on opportunities to encourage good health, safety, and nutritional practices.
talk with professionals (e.g., doctors, dentists, fire personnel)
cook a variety of food and learn about good nutrition
observe and care for living things such as pets
provide programs either through Air Force, Boys Girls Clubs of America,
4-H, or locally, that increase nutritional awareness
other
8 / S10 / This criterion may also be met during the observation portion of the inspection. For the last quarter of activity plans, annotate S10 after each activity which supports developmentally appropriate opportunities to enhance language and literacy skills by being active listeners, extending conversations, reading books, and encouraging discussions.
write plays or stories
other
9 / S19 / Evidence to support youth have input for new materials, supplies, and equipment for SAC
10 / S24 / Evidence parents are provided an orientation at the time of initial enrollment
11 / S25 / A copy of the current Parent Handbook with the following topics tabbed:
a list of key personnel
a list of community resources
any topics required by accrediting agencies
operating hours
financial policies
medical/health policies
emergency procedures/plans
termination/suspension of enrollment
supporting youth and families with special needs
child abuse and neglect reporting
transportation and field trips
alcohol, drugs, and tobacco products policies
plan for communicating with parents
notification all youth may be subject to closed circuit video monitoring and
recording as part of their participation/enrollment in CYP
12 / S27 / Copies of Parent Advisory Board meeting minutes for the last 12 months to include:
quarterly meetings
highlight Airman and Family Services Flight Chief’s quarterly
attendance
highlight SAC Coordinator’s quarterly attendance
highlight Mission Support Group Commander annual attendance
evidence they were forwarded to MSG/CC
13 / S28 / Evidence SAC plans programs and events with youth including parents and other family members
parents and other visitors are invited to participate in classroom activities
annually, SAC offers or co-sponsors a parent education event
14 / S29 / Copies of Quality Improvement Team meeting minutes for the last 12 months to include:
list of representatives with their affiliation
current Action Plan
implements improvement measures identified in plan
quarterly meetings
15 / S30 / Results of Monthly Fire Inspections
current AFCEC Fire Inspection Guide was used
16 / S30 / Results of Monthly Safety Inspections
17 / S30 / Results of Monthly Health Inspections
18 / S46 / Results of two shelter-in-place drills
19 / S47 / Results of 14 fire evacuation drills
two during the first week of the school year
two during the first week of the summer program
20 / S48 / Current Pet Certificates on all pets
21 / S61 / Current Fiscal Year APF distribution
22 / S62 / Current Income and Expense Report
23 / S79 / Copies of current approved cycle menus in use
24 / S107 / Documentation to support CYP Management meets monthly with SAC Personnel
25 / S123 / Evidence to support SAC Teaching Staff are provided assistance and training to obtain their
Military School-Age Credential
Youth Administrative Files – 12 files selected by the inspector(s)
S69 arranged in accordance with the CYP Child and Youth File Plan
S70 AF Form 1181, Youth Flight Program Patron Registration
S70 copy of current and up-to-date immunization record
S71 DD Form 2652, Application for Department of Defense Child Care Fees
S59 AF Form 1187, Youth Flight Accident Report
Administration
S43 current allergy list
S43 youth folders for those identified on the allergy list
S58 last 30 days of the AF Forms1929, Child Development Center Daily Reservation Log
S59 last 12 months of the AF Form(s)1023, Youth Flight Record of Injuries
S66 list of families enrolled on a space available basis
S67 if applicable, all current DD Form(s) 2606, DoD Child Development Program Request for Care Record
S71 list of families, who have been granted a reduction in fees Hardship Waiver within the last 12 months
S72 list of youth identified with a special need and their Inclusion Action Team recommendations
S73 list of youth who are currently on an Individualized Behavior Support Plan
S74 current/active AF Form(s) 1055, Youth Flight Medication Permission Form
S86 inspection days only - review of AF Form(s) 1930, Daily Attendance in Youth Programs
S90 inspection days only - review of AF Form(s) 1109, Visitor Record Log
Daily Inspections – to be reviewed for the inspection days only
S31 daily Fire Inspections
S31 list of all Staff who are trained to conduct DailyFire Inspections
S32 daily Safety Inspections
S32 list of all Staff who are trained to conduct DailySafety Inspections
S33 daily Health Inspections
S33 list of all Staff who are trained to conduct DailyHealth Inspections
S34 daily Playground Inspections
S34 list of all Staff who are trained to conduct Daily Playground Inspections
List of all current Staff, Specified Volunteers (SV), and Contract Workers (CW) (including custodial workers who are present when youth are in care)
- indicate position and grade
- for NAF SAC Teaching Staff, indicate regular or flex
- if applicable, indicate first aid expiration date
- if applicable, indicate CPR expiration date
S106 the position description/guide/contract
S109 the results of all required background checks
S109 the results of two reference checks (personal, professional, or educational)
S110 the DD Form 2981, Basic Criminal History and Statement of Admission
S106 signed Air Force CYP Positive Guidance and Appropriate Touch Instructional Guide
S108 the most recent performance evaluationto include self-evaluation
S106 a copy of their high school diploma or equivalent and/or college transcripts
S106 current physical examination date (employees only)
S106 a copy of the current and up-to-date immunization record
S106 if transporting youth, a copy of the Department of Motor Vehicles (DMV) driving record (must be
updated annually)
S106 a signed DD Form 2793, Volunteer Agreement for Appropriated Fund Activities/Nonappropriated
Fund Instrumentalities (SV only)
Tab the following items – in all SAC Program employee/SV/installation instructional CW training folders
S111 current and previous years’ AF Forms 1098
S112 CYP Managers AF Form 1098/CYP T&C AF Form 1098
S113 Administrative and Food Service Staff position specific standardized orientation AF Form 1098
S114 CYP Administrative AF Form 1098
S115 CYP Cooks/Food Service Workers AF Form 1098
S116 CYP Teaching Staff NEO AF Form 1098
S117 SAC Teaching Staff receive New Employee Training (NET)
S118 SAC Teaching Staff AF Form 1098
S119 Teaching Staff/CYPA/FCC Provider DTM Debrief AF Form 1098
S120 SAC Teaching Staff Module 1098 or Module Completion Certificate
S124 CYP Special Volunteer/Contract Worker Orientation AF Form 1098
S124 CYP Specified Volunteer/Contract Worker AF Form 1098
S125 contract custodians annual training on child maltreatment prevention, identification, and
reporting
2016 SAC Inspection Criteria Documentation ListPage 1 of 4