OAC 173-39-02.12 · Nursing License & Certification Tracking

Licensure Tracking Log

Dulla Care Home Healthcare

All nursing licenses re-verified annually via the Ohio eLicense Portal · Renewal dates tracked to expiration

10

Total Tracked

0

Verified This Cycle

0

Expiring ≤60 Days

0

Expired

HR Director

Annual Review Period

Log Date

Next Annual Re-Verification

#Employee
Name
PositionLicense /
Cert Type
License
Number
Issuing
State
Issue
Date
Expiration
Date
Days
Remaining
Last Verified
Date
Next Annual
Verification
Verified
By
Verification
Result
Renewal
Submitted?
Renewed
Date
Notes
1—
2—
3—
4—
5—
6—
7—
8—
9—
10—

🔗 Ohio eLicense Portal — Annual Re-Verification Protocol

  1. HR accesses the Ohio eLicense Portal at https://elicense.ohio.gov to verify each nursing license annually.
  2. For each licensee, HR searches by name or license number and confirms: license status (Active), expiration date, and any disciplinary actions or restrictions.
  3. HR records the verification date, verifier name, and verification result in this log above.
  4. Licenses expiring within 60 days are flagged amber; expired licenses are flagged red and the employee is removed from service immediately.
  5. Renewal submissions are tracked in the "Renewal Submitted?" and "Renewed Date" columns; updated licenses are re-verified after renewal.
  6. Non-nursing certifications (CPR, First Aid, BLS) are verified through their respective issuing organizations (e.g., American Heart Association, Red Cross).
  7. STNA registry verification is conducted via the Ohio Department of Health Nurse Aide Registry.
  8. This log is reviewed annually and re-verifications are conducted at least once per year per license/certification.

HR Director / Licensure Verifier Signature

Signature & Date

Administrator Approval

Signature & Date

Dulla Care Home Healthcare · Licensure Tracking Log · OAC 173-39-02.12 · Ohio eLicense Portal Annual Re-Verification · Confidential

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