REOPENING REQUEST FORM – Early Learning Centers
Program Type
*
Type I
Type II
Type III
Name of Storm
*
License Number
*
Parish
*
TIPS Number
(If applicable)
Center Name
*
Email Address
*
Center Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Center Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Section 1:
Please check one of the following statements below:
*
This center DID NOT sustain damage and was able to continue operation.
This center DID NOT sustain damage and is expected to reopen.
This center DID sustain minimal damage and is expected to reopen.
This center DID sustain major damage and is expected to reopen.
This center did sustain damage and WILL NOT REOPEN.
Effective Operation Date:
-
Month
-
Day
Year
Date
Expected Reopening Date:
-
Month
-
Day
Year
NOTE: If reopen date changes, contact your Licensing Consultant.
Effective Closure Date:
-
Month
-
Day
Year
Date
Section 2:
Did the center sustain any major structural damage to include fence?
Yes
No
Describe type of damage:
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Are all utilities (water, sewages, electricity) currently operating normally?
Yes
No
Was electricity off for more than 48 hours? (Note: If yes, it is your responsibility to destroy and dispose of any food or food items properly.)
Yes
No
If the center lost electricity, has electricity been restored by the electric company?
Yes
No
N/A
Is the center operating on generator power?
Yes
No
Is your facility located in an area that was subject to a boil advisory?
Yes
No
Did any flood water enter the center? (Note: If yes, it is your responsibility to destroy and properly dispose of any items that came into contact with flood waters.)
Yes
No
Is there any visible mold in your center or has your center been treated for mold remediation?
Yes
No
Is the fire alarm system working?
Yes
No
Are the smoke detectors working?
Yes
No
Do you have a sprinkler system?
Yes
No
If you have a sprinkler system, it is in working order?
Yes
No
N/A
Are the exits free and unobstructed?
Yes
No
Are the exit doors in proper working condition?
Yes
No
Additional Comments:
Section 3:
Who completed the form?
*
Owner
Director
Other
Submit
Should be Empty: