xxxx DE Application Appendix E

Appendix E: Provider Checklist for Adequacy of Facilities
(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider:
Other business names used at this location, if any:
Street address:
County:
Business hours:
CHECK ONE 

REQUIRED ELEMENT

EXPLANATION

YES

NO

Handicapped accessible building
and room.

No steps at door entry or at
wheelchair ramp, rail. Meets
specifications of Americans with
Disabilities Act Accessibility
Guidelines (ADAAG).

YES

NO

Handicapped accessible restrooms.

Meets ADAAG.

YES

NO

Close to public transport.

Location within ½ mile of bus stop
or reasonable distance from public
transportation if available in the
area.

YES

NO

Convenient parking and physically
challenged designated parking
available.

YES

NO

Facility meets standard building
safety codes.

YES

NO

Facility does not exceed occupancy
requirements for safety, fire, or
health codes, rules, or laws.

Occupancy permit for intended use
and number of occupants.

YES

NO

Facility meets fire/life and health
codes, rules or regulations.

Established exit, fire alarm,
sprinkler, or safety requirements
are met.

YES

NO

Facility does not contain hazardous
materials.

Facility is free of hazardous
materials according to federal,
state, and local environmental rules
or regulations.

YES

NO

Facility has adequate liability
insurance coverage.

THIS CHECKLIST IS NOT AN EXCLUSIVE OR EXHAUSTIVE LIST OF ELEMENTS
THE UNITED STATES TRUSTEE MAY CONSIDER IN DETERMINING WHETHER A
FACILITY IS ADEQUATE.
I declare under penalty of perjury that I have reviewed the information provided on this checklist
and it is true and correct to the best of my knowledge, information, and belief.
______________________________________

_______________________________________

Signature of Owner, President, Chairman, Trustee, or
Other Authorized Official

Type or Print Name of Signer

______________________________________

_______________________________________

Type or Print Title of Signer (if applicable)

Date