Form CFS 2003 On-Site Visit License-Exempt and Unlicensed Day Care Provider - Illinois

Form CFS2003 or the "On-site Visit License'-exempt And Unlicensed Day Care Provider" is a form issued by the Illinois Department of Children and Family Services.

The form was last revised in July 1, 2018 and is available for digital filing. Download an up-to-date Form CFS2003 in PDF-format down below or look it up on the Illinois Department of Children and Family Services Forms website.

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CFS 2003
Rev. 7/2018
State of Illinois
Department of Children and Family Services
ON-SITE VISIT
LICENSE–EXEMPT and UNLICENSED DAY CARE PROVIDER
DAY CARE PROVIDER’S NAME
DAY CARE PROVIDER’S ADDRESS
Indicate by a check mark if this child care is for:
Placement
Intact Family Case
Indicate by a check mark the reason why this provider/facility is exempt from licensing.
Home Care
All children under 12 years of age are related to the caregiver.
All children under age 12 in care, besides the caregiver’s own children under age 12, are from the same
household.
No more than 3 unrelated children under age 12 are present, including the caregiver’s own children
under age 12.
Care is being provided in the child’s home/foster home.
Out of Home Care (if applicable)
Facility operated by a public or private elementary or secondary school or college or university and no
children are under age 3
Facility is federal government property.
Program is operated by a church or social service agency and no individual child is present more than 10
hours in a seven-day week
Program is short-term, special activity program operated by civic, charitable, or governmental
organization.
Caseworker must document that the following conditions have been met by checking each item below.
A CANTS check has been completed on all members of the household age 13 years and older.
All unrelated caregivers 18 years and older have been fingerprinted and cleared a Background Check
(CANTS, Sex Offender Registry and FBI checks)
Prescription and non-prescription drugs, dangerous household supplies and dangerous tools are stored in
places inaccessible to children
CFS 2003
Rev. 7/2018
State of Illinois
Department of Children and Family Services
ON-SITE VISIT
LICENSE–EXEMPT and UNLICENSED DAY CARE PROVIDER
DAY CARE PROVIDER’S NAME
DAY CARE PROVIDER’S ADDRESS
Indicate by a check mark if this child care is for:
Placement
Intact Family Case
Indicate by a check mark the reason why this provider/facility is exempt from licensing.
Home Care
All children under 12 years of age are related to the caregiver.
All children under age 12 in care, besides the caregiver’s own children under age 12, are from the same
household.
No more than 3 unrelated children under age 12 are present, including the caregiver’s own children
under age 12.
Care is being provided in the child’s home/foster home.
Out of Home Care (if applicable)
Facility operated by a public or private elementary or secondary school or college or university and no
children are under age 3
Facility is federal government property.
Program is operated by a church or social service agency and no individual child is present more than 10
hours in a seven-day week
Program is short-term, special activity program operated by civic, charitable, or governmental
organization.
Caseworker must document that the following conditions have been met by checking each item below.
A CANTS check has been completed on all members of the household age 13 years and older.
All unrelated caregivers 18 years and older have been fingerprinted and cleared a Background Check
(CANTS, Sex Offender Registry and FBI checks)
Prescription and non-prescription drugs, dangerous household supplies and dangerous tools are stored in
places inaccessible to children
Any firearms and ammunition are stored separately and storage is kept locked at all times.
Basic utilities – water, heat, and lighting – are in operation.
Napping/sleeping arrangements are suitable for the sex and age of child(ren).
Age-appropriate supervision of the child(ren) can be assured at all times.
Meals are provided daily to the child(ren) in sufficient quantities to meet the child(ren)’s nutritional
needs.
The medical needs of the child(ren) can be met. The provider has been informed about procedures for
obtaining medical treatment and/or guardian consent.
No member of the household/staff appears to have a communicable disease which could affect the
health of the child(ren).
There is no reasonable suspicion of current drug or alcohol abuse on the part of any household member
as determined by the placing agency observations and statements by the day care provider.
The day care provider has emergency information for the child(ren), including how to contact the
parent/foster parent/guardian and the child(ren)’s caseworker.
The day care provider has immediate access to a telephone.
The day care provider will cooperate with parent/foster parent/guardian to ensure child(ren) attend
school.
Smoke detectors are functioning properly and placed in the recommended safety areas of the
residence/facility.
Carbon monoxide detectors are functioning properly and placed in the recommended safety areas of the
residence/facility.
Safe sleep practices have been established and followed in the home/facility
The home/facility is free of any observable hazards
All previous identified hazards have been rectified prior to child day care beginning.
An on-site visit has been made with this day care provider and the foregoing conditions have been met.
Caseworker Name (Print)
Name of DCFS Office/Private Agency
Caseworker Signature
Date
Supervisor Name (Print)
Supervisor Signature
Date

Download Form CFS 2003 On-Site Visit License-Exempt and Unlicensed Day Care Provider - Illinois

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