NEW HIRE PERSONNEL CHECKLIST Agency Name: ____________________________________ Date: ______________ Reviewer: _________________________________ KY KY only 12 used days for KY (prior or for 30 Permit past for vehicle KARES background Work KARES KARES beginning or within (within the or KARES or or licensure SCL state KY or for Test of of hire) TB (AOC) (CAN) Registry hire) out Functioning Number of applicable Check or to if 6/3/2016; outside professional Check Check were License Insurance days applicable participant hire) a 30 if (prior Security Registry yes, Misconduct to Record worked hire) If Driver's current Orientation Registry Liability Assessment Education, Independent completed? beginning Aide Position of or to of Social Screen Date of (within (prior Description Risk hire) hire) transport months? Name and Waiver(s) Nurse Hire Date Drug Agency Criminal Central only Caregiver only of Valid Current Current Title/ 4/2/2017) TB Proof Lived checks certification, to to (MPW (prior Job NEW HIRE PERSONNEL CHECKLIST
NEW HIRE PERSONNEL CHECKLIST Agency Name: ____________________________________ Date: ______________ Reviewer: _________________________________ Name and Waiver(s) Title/ Position Hire Date Date of Independent Functioning Criminal Record Check (AOC) or KARES (prior to hire) Central Registry Check (CAN) or KARES for KY only (within 30 days of hire) Caregiver Misconduct Registry or KARES for KY only (prior to hire) (MPW beginning 6/3/2016; SCL beginning 4/2/2017) Nurse Aide Registry Check or KARES for KY only (prior to hire) Lived or worked outside of KY within past 12 months? If yes, were out of state background checks completed? Drug Screen (prior to hire) TB Risk Assessment or TB Test (within 30 days of hire) Valid Social Security Number or Work Permit Current Driver's License Current Liability Insurance for the vehicle used to transport a participant Proof of current professional licensure or certification, if applicable of Education, if applicable Job Description Agency Orientation NEW HIRE PERSONNEL CHECKLIST
Checklist-PersonnelNHE.docx