1. Type of Program? Family Home Group Home Center 2. Type of Inspection? New License Renewal 90% Day Interim Complaint   Other (specify) 3. Were you at the facility when the onsite inspection was conducted? Yes No Not Applicable   If yes, are you: The licensee? The licensee designee? Program Director?   Other Title: 4. Was the inspection process clearly explained to you by your licensing consultant? Yes No N/A 4a. Comments 5. Were you treated professionally by your licensing consultant? Yes No N/A 5a. Comments 6. Were your staff and the children in care treated professionally by your licensing consultant? Yes No N/A 6a. Comments 7. Did your licensing consultant answer all of your questions? Yes No N/A 7a. Comments 8. If rule violations were identified, were you provided with technical assistance (TA) to assist you in meeting the requirements of the act and the rules? Yes No N/A 8a. Comments 9. Were you offered or provided consultation to assist you in developing methods for improving your program? Yes No N/A 9a. Comments 10. Are you aware that the TA and Consultation Manual is available online? Yes No N/A 10a. Comments 11. Did your licensing consultant provide any positive comments on your program? Yes No N/A 11a. Comments 12. Were you provided an opportunity to review the inspection findings to clarify incorrect or missing information? Yes No N/A 12a. Comments 13. Using the following scale, check the number that applies. The inspection process was helpful to me and accurately assessed my facility's compliance with the rules and the care I provide for children. 1 Strongly Disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly Agree 14. Any additional comments:   Name of licensing consultant who conducted the inspection:   Please provide your contact information.   Facility Name:   Your Name:   Your Phone #:   E-mail Address:   License #: