DHS - Licensing Inspection Questionnaire

Skip Navigation

Michigan.gov, Official Website for the State of Michigan


>	Licensed Provider Resources
	Billing and Payments
	Rules and Statutes
	Technical Assistance
	Inspections for Child Care Centers
	Newsletter
	Training
	Resources
	Forms
>	Unlicensed Providers
>	Parent Resources

Assistance & Services

Abuse & Neglect

Foster Care & Adoption

Child Support

Doing Business with DHS

Inside DHS

Newsroom

Forms and Publications

close print view

print friendly email this page

Licensing Inspection Questionnaire

1.	Type of Program? Family Home Group Home Center
2.	Type of Inspection? New License Renewal 90% Day Interim Complaint
	Other (specify)
3.	Were you at the facility when the onsite inspection was conducted? Yes No Not Applicable
	If yes, are you: The licensee? The licensee designee? Program Director?
	Other Title:
4.	Was the inspection process clearly explained to you by your licensing consultant? Yes No N/A
4a.	Comments
5.	Were you treated professionally by your licensing consultant? Yes No N/A
5a.	Comments
6.	Were your staff and the children in care treated professionally by your licensing consultant? Yes No N/A
6a.	Comments
7.	Did your licensing consultant answer all of your questions? Yes No N/A
7a.	Comments
8.	*If rule violations were identified, were you provided with technical assistance* (TA) to assist you in meeting the requirements of the act and the rules?** Yes No N/A
8a.	Comments
9.	*Were you offered or provided consultation* to assist you in developing methods for improving your program?** Yes No N/A
9a.	Comments
10.	*Are you aware that the TA and Consultation Manual* is available online?** Yes No N/A
10a.	Comments
11.	Did your licensing consultant provide any positive comments on your program? Yes No N/A
11a.	Comments
12.	Were you provided an opportunity to review the inspection findings to clarify incorrect or missing information? Yes No N/A
12a.	Comments
13.	Using the following scale, check the number that applies. The inspection process was helpful to me and accurately assessed my facility's compliance with the rules and the care I provide for children. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree
14.	Any additional comments:
	Name of licensing consultant who conducted the inspection:
	Please provide your contact information.
	Facility Name:
	Would you like someone to contact you? Yes No
	Your Name:
	Your Phone #:
	E-mail Address:
	License #:
	* Spam Block: (What's this?) Add four plus nine and type the answer here: