GCC-02
Insurance Policy Coverage Please provide a copy of the current and unexpired certificate of liability insurance coverage policy.<br/>
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Home › HI › Honolulu › Pact Kalihi Elementary Head Start
License #13467 · Center · Group Child Care Center
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This annual/biennial licensing inspection recorded no violations or advisories.
This off-year / other inspection recorded no violations or advisories.
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Data synced from Hawaii Executive Office of Early Learning / PATCH on Jul 14, 2026 · Source records · Report an error
Insurance Policy Coverage Please provide a copy of the current and unexpired certificate of liability insurance coverage policy.<br/>
Written evidence of fire warning device inspected initially and annually by fire inspector. report dated: 10/26/2023 The fire inspection that was conducted on 10/26/2023 by HFD Inspector, T. Ishii indicates deficiencies were found specifically the designated fire extinguisher located in classroom A15 has lost charge.<br/> <br/> Please correct the deficiency then have the inspector do a re-inspection. Once you receive a satisfactory fire inspection, please provide us with a copy showing that the deficiency was corrected.<br/>
Employment History Check for Please submit completed DHS 959 Employment History Clearance Form(s) for XXXXX specifically for the employment period between January 2021 to January 2022 to cover the three years of the employee's date of employment with your center.<br/> <br/> Employment History Instructions:<br/> <br/> Required individuals shall complete the form DHS 959A "Self Certification of Employment" and list the places of employment within the past three (3) years including periods of unemployment, self-employment, and periods of school attendance. For every place of employment listed, complete and sign Part I of the DHS 959 "Employment History Clearance Form" (EHC) and have the former and/or current employer complete and sign part II.<br/> <br/> Please complete the following information on form DHS 959A- The date EHC mailed and the date EHC returned. Keep copies of all forms mailed out to former employers. If EHC forms are not returned after the first try, mail out the copy again in a few weeks and log the 2nd date mailed. If forms are not returned after the second try, we will accept the written self-certification that two mailed attempts were recorded on the DHS 959A.<br/> <br/> <br/> DHS forms are downloadable at: https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Employment history check Please submit the completed DHS 959A Self-Certification of Employment form and DHS 959 Employment History Clearance Form for XXXXX.<br/> <br/> Note: Employment history for the three (3) years prior to their employment date with your program is required for each employee. Please document each mail out to each employer. If you don't receive a response from the previous employers after the first mail out, do a second attempt two weeks later. If you don't receive any response from the employee's previous employers, we will accept two documented mail attempts as meeting this requirement.<br/> <br/> Please submit a DHS 974A Notification of Change form for any staff members who are no longer employed with the site.<br/> <br/> DHS forms are downloadable at:<br/> <br/> https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/> <br/> --------------------------------<br/> The incomplete DHS 959A and DHS 959 forms were received for Abcd Taaina on 4/19/2024. Email was sent on 5/9/24 to submit the complete forms.<br/>
Insurance coverage policy Please provide a copy of the current and unexpired certificate of liability insurance coverage policy.<br/>
Protected area for children to use equipment and materials The worker inspected the jungle gym in the school playground and discovered rusted metals fraying in two visible areas of the play structure:<br/> <br/> 1. The top platform of the slide.<br/> 2. The bottom area underneath of the play structure.<br/> <br/> Please provide photographs showing the areas have been repaired.<br/>
Physical exam clearance Please submit a completed DHS 984 Medical Report form that shows a physical exam and TB clearances was completed within 1 year from start of employment with your center for XXXXX.<br/> <br/> NOTE: DHS forms are downloadable via https://humanservices.hawaii.gov/bessd/child-care-program/child-care-licensing/child-care-center-Licensing-forms/<br/>
Written evidence of fire warning device inspected initially and annually by fire inspector. report dated: The fire inspection that was conducted on 10/26/2023 by XXXXX indicates deficiencies were found specifically the designated fire extinguisher located in classroom A15 has lost charge.<br/> <br/> Please correct the deficiency then have the inspector do a re-inspection. Once you receive a satisfactory fire inspection, please provide us with a copy showing that the deficiency was corrected.<br/>
Activities and premises minimizes risk of accidental injury While observing outdoor activities, the worker discovered the end of the pathway leads to an open down sloping grassing area, which could be a safety hazard to children.<br/> <br/> Please provide photographs showing that there are safety cones being used to direct children turn around back to the direction of the classroom.<br/>