Form SFN 1130 Enrollment and Staffing Schedule - North Dakota

Form sfn1130 is a North Dakota Department of Human Services form also known as the "Enrollment And Staffing Schedule". The latest edition of the form was released in September 1, 2011 and is available for digital filing.

Download a fillable PDF version of the Form sfn1130 down below or find it on North Dakota Department of Human Services Forms website.

ADVERTISEMENT
Provider:
Clear Fields
HOUR BY HOUR ENROLLMENT AND STAFFING SCHEDULE
Address:
FOR GROUP CHILD CARE
ND DEPARTMENT OF HUMAN SERVICES/CFS
Date Form Completed:
SFN 1130 (Rev. 9-2011)
New License:
Renewal:
Unannounced
Review:
License Number:
Expiration Date:
Compliance:
Yes
No
TIME OF THE DAY (6 a.m. - 6 - p.m.)
AGE CATEGORY CHILD RATIO
MAXIMUM NUMBER OF CHILDREN
MAXIMUM GROUP SIZE
SCHEDULED PER DAY
6 a.m.
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.
12 Noon
1 p.m.
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
Number of Children Scheduled:
Birth to 18 months
Number of Staff Present:
Cannot Exceed Ratio 1:4
X .25
Required Caregivers:
Number of Children Scheduled:
18 months - 36 months
Number of Staff Present:
Cannot Exceed Ratio 1:5
X .20
Required Caregivers:
Number of Children Scheduled:
3 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:7
X .14
Required Caregivers:
Number of Children Scheduled:
4 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:10
X .10
Required Caregivers:
Number of Children Scheduled:
5 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:12
X .08
Required Caregivers:
Number of Children Scheduled:
6 - 12 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:18
X .05
Required Caregivers:
Number of Children Scheduled:
Special Needs Children
Number of Staff Present:
When More Than Usual Care
Use Developmental Age
Required Caregivers:
TOTAL
NUMBER OF CHILDREN SCHEDULED
NUMBER OF STAFF PRESENT
REQUIRED CAREGIVERS
Provider:
Clear Fields
HOUR BY HOUR ENROLLMENT AND STAFFING SCHEDULE
Address:
FOR GROUP CHILD CARE
ND DEPARTMENT OF HUMAN SERVICES/CFS
Date Form Completed:
SFN 1130 (Rev. 9-2011)
New License:
Renewal:
Unannounced
Review:
License Number:
Expiration Date:
Compliance:
Yes
No
TIME OF THE DAY (6 a.m. - 6 - p.m.)
AGE CATEGORY CHILD RATIO
MAXIMUM NUMBER OF CHILDREN
MAXIMUM GROUP SIZE
SCHEDULED PER DAY
6 a.m.
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.
12 Noon
1 p.m.
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
Number of Children Scheduled:
Birth to 18 months
Number of Staff Present:
Cannot Exceed Ratio 1:4
X .25
Required Caregivers:
Number of Children Scheduled:
18 months - 36 months
Number of Staff Present:
Cannot Exceed Ratio 1:5
X .20
Required Caregivers:
Number of Children Scheduled:
3 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:7
X .14
Required Caregivers:
Number of Children Scheduled:
4 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:10
X .10
Required Caregivers:
Number of Children Scheduled:
5 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:12
X .08
Required Caregivers:
Number of Children Scheduled:
6 - 12 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:18
X .05
Required Caregivers:
Number of Children Scheduled:
Special Needs Children
Number of Staff Present:
When More Than Usual Care
Use Developmental Age
Required Caregivers:
TOTAL
NUMBER OF CHILDREN SCHEDULED
NUMBER OF STAFF PRESENT
REQUIRED CAREGIVERS
Provider:
SFN 1130 (Rev. 9-2011)
Page 2 of 2
Address:
Date Form Completed:
New License:
Renewal:
Unannounced
Review:
License Number:
Expiration Date:
Compliance:
TIME OF THE DAY (6 p.m. - 6 - a.m.)
Yes
No
AGE CATEGORY CHILD RATIO
MAXIMUM NUMBER OF CHILDREN
12
6 p.m.
7 p.m.
8 p.m.
9 p.m.
10 p.m.
11 p.m.
Midnight
1 a.m.
2 a.m.
3 a.m.
4 a.m.
5 a.m.
6 a.m.
MAXIMUM GROUP SIZE
SCHEDULED PER DAY
Number of Children Scheduled:
Birth to 18 months
Number of Staff Present:
Cannot Exceed Ratio 1:4
X .25
Required Caregivers:
Number of Children Scheduled:
18 months - 36 months
Cannot Exceed Ratio 1:5
Number of Staff Present:
X .20
Required Caregivers:
Number of Children Scheduled:
3 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:7
X .14
Required Caregivers:
Number of Children Scheduled:
4 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:10
X .10
Required Caregivers:
Number of Children Scheduled:
5 Year Olds
Cannot Exceed Ratio 1:12
Number of Staff Present:
X .08
Required Caregivers:
Number of Children Scheduled:
6 - 12 Year Olds
Number of Staff Present:
Cannot Exceed Ratio 1:18
X .05
Required Caregivers:
Number of Children Scheduled:
Special Needs Children
Number of Staff Present:
When More Than Usual Care
Use Developmental Age
Required Caregivers:
TOTAL
NUMBER OF CHILDREN SCHEDULED
NUMBER OF STAFF PRESENT
REQUIRED CAREGIVERS
ADVERTISEMENT
Page of 2