Form Overview Please complete this online form after your Child Care Advisor has completed your Quarterly Safety Check. Which Child Care Advisor conducted your safety check? *Please select your Child Care Advisor...Sandra ZitoRebecca PooleMarg GrovesSadaf AnsariCarrie KoenigSandra CarquezI Can't RememberYour Full Name *Your Email AddressConfirmation Checkbox *I confirm that the home visitor has reviewed the results of the inspection with me and that, where non-compliances have been identified, I clearly understand the requirements and action plan that must be followed.My safety check was conducted: *Please choose...Via PhoneVia VideoIn PersonVia emailDate of Safety Check: *Signature of Home Child Care Provider *Start signing your signature hereYour browser does not support e-Signature field.SubmitPlease do not fill in this field.
