Forms for Nevada Licensed Child Care Facilities

Statewide Annual Licensing Report

This report provides a glimpse of child care numbers crossing jurisdictional lines by giving total number of licensed facilities, number of each type of facility licensed, number of substantiated and unsubstantiated complaints and more throughout Nevada.

• 2021 January-June Statewide Nevada Child Care Licensing Report

Forms - Background

Listed below are the required forms to be completed by every child care facility owner and employee (age 18 and older) for the required background check per NRS 432A.175.

• Fingerprinting Instructions
• Background Check Consent and Release
• List of Disqualifying Crimes
• Scope, Severity and Sanction Matrix

Forms - License Renewal

These forms are required for your renewal application. They should be completed and attached to your online renewal application in the checklist section.

• Center-Group-Family Listings of Trainings
• Institution Listing of Trainings
• Listing of Employees/Residents

Sample Forms - Facility Logs

Listed below are samples of logs needed in the ongoing operation of a licensed Nevada child care facility. They may be used as posted here or you can create your own versions.

• Fire/Disaster Drill
• Substantiated Complaints Log (Parent Form)
• Transportation Log
• Carpet Cleaning Log

Sample Forms - Daily Operations

Listed below are samples of forms needed in the day-to-day operation of a licensed Nevada child care facility. They may be used as posted here or you can create your own versions.

• Abuse and Neglect Reporting Form
• Accident/Incident Form
• Child Record Form
• Employee Training Form
• Phone Emergency List Form
• Facility Right to View Complaints Statement
• Field Trip Permit Form
• Health Statement
• Infant Daily Report
• Medication Request Form
• Permission to Release Information Form
• Sign In/Out Form