Form LIC 507. Facilities Staff Work Schedule - California

Form LIC 507 is used in California to document the work schedules of staff members in licensed facilities or programs. The main purpose of this form is to ensure proper staffing levels and compliance with licensing regulations regarding staff-to-individual ratios.

The form consists of sections where the facility provides details about the work schedule of its staff members, including their names, positions, shifts, and any breaks or time off. The form may also include spaces for capturing the dates, times, and locations of the staff members' shifts. Additionally, the form may require the facility representative's signature and date of submission.

Important fields on this form include accurately documenting the work schedules of staff members, ensuring compliance with applicable regulations regarding staff-to-individual ratios and adequate supervision, and maintaining records that can be readily available for review by regulatory authorities. It is crucial for the facility to create and adhere to work schedules that meet the needs of individuals under care while complying with licensing requirements.

Application Example: A residential facility for adults with disabilities in California prepares the work schedule for its direct care staff. Form LIC 507 would be used by the facility to document the work schedules of staff members, ensuring appropriate staffing levels and compliance with licensing regulations. By completing the form, the facility maintains a record of staff schedules, promotes effective supervision and care for individuals with disabilities, and demonstrates adherence to licensing requirements.

Related Forms: While no specific related forms are mentioned for Form LIC 507, other documentation such as shift change request forms, time-off requests, and staffing logs may be used in conjunction with this form to ensure accurate tracking of staff schedules and compliance with regulatory requirements.