Building Inspectors Inspection Form For Child Care Centers
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1
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5Identification #
DCD-0304
County
Rev. 9/08
Date of Inspection
BUILDING INSPECTORS INSPECTION FORM FOR CHILD CARE CENTERS
NAME OF OPERATION
ADDRESS
TELEPHONE:
CITY
STATE
ZIP
BUILDING INSPECTORS CERTIFICATE
1.
The areas in the building that are designated as the licensed space are required by the licensing agency
to meet the Building Code in effect when an application for licensure is submitted to the regulating agency.
Does the building listed above, to the extent observable, meet the current North
Carolina Building Code?
Yes____ No____
2.
If no, list question numbers which do not comply, explain the violation and whether equivalent protection
for the safety of the children is provided:
1)
2)
3)
4)
3
Are any of the above violations of a life safety concern?
Yes
No
If yes, please list question numbers _______________________________
4.
In your opinion based on the violations listed above, do you recommend that the
Division of Child Development issue a provisional license to allow time for
correction of the violations?
Yes
No
If yes, how long (30-60-90 days) and for which violations?
(Note: All violations must be corrected before a license can be issued unless a provisional time period is
recommended or equivalent protection is documented.)
5.
Number of rooms approved for occupancy by children?
(Attach sketch of building with rooms identified)
6.
Specify any local zoning restriction:
Signature of Inspector __________________________________________/Date
Jurisdiction
/Phone:
The Inspectors Certificate and Building Inspection Form is required to be completed in its entirety before the Division of Child
Development (DCD) can consider the document complete. All questions must be answered; any NO answers must have a written
explanation.
This form was developed through the cooperation of the Division of Child Development and the Engineering Division of the Department of
Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be used as a guide for the local inspector. If
additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on the back of this
form.
Prepare in quadruplicate: Original & copy to DCD, 1 copy kept by inspector, 1 copy kept by operator.
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