Edit with
OAC 173-39-02.12 · Pre-Hire Screening Compliance
Dulla Care Home Healthcare
All background checks must be completed and evidence retained in the personnel file before a start date is set.
⚠️ Policy
No employee may begin orientation or provide services until all required background checks are completed, results reviewed, and evidence is retained in the personnel file. The hiring manager must sign this checklist to verify all checks are complete before a start date is set.
| ✓ | Background Check | Database / Source | Date Run | Result | Evidence Location |
|---|---|---|---|---|---|
| BCI (Bureau of Criminal Identification) WebCheck | Ohio BCI | ||||
| FBI Fingerprint Background Check (WebCheck) | Federal Bureau of Investigation | ||||
| Ohio Nurse Aide Registry Check | Ohio DODD Nurse Aide Registry | ||||
| ABLE (Advocating for a Better Living Environment) Check | Ohio DODD ABLE Registry | ||||
| DODD Excluded Provider List Check | Ohio DODD Excluded Provider List | ||||
| Ohio Department of Health Exclusion Check | ODH Provider Exclusion List | ||||
| Ohio Medicaid Exclusion Check | Ohio Medicaid Excluded Provider List | ||||
| OIG (Office of Inspector General) Exclusion Check | Federal OIG LEIE | ||||
| SAM.gov Exclusion Check | Federal SAM.gov Exclusions | ||||
| Sex Offender Registry Check | Ohio eSORN / National Sex Offender Registry | ||||
| Child Abuse & Neglect Registry Check | Ohio Central Registry on Child Abuse | ||||
| BMV Driving Record (if transporting consumers) | Ohio BMV |
⚠️ Disqualifying Offense Policy
If any background check reveals a disqualifying offense under OAC 173-39-02.12 or applicable Ohio law, the applicant shall not be hired. The results and determination shall be documented and retained in the personnel file. If hired under the 60-day conditional period, the employee must be removed from the schedule if permanent results are not received within 60 calendar days.
By signing below, we certify that all required background checks have been completed, results reviewed, and evidence retained in the personnel file. The applicant is cleared to begin employment on the start date listed above.
✍️ Hiring Manager Attestation
I, [Hiring Manager Name], in my capacity as Hiring Manager at Dulla Care Home Healthcare, hereby attest and verify that I have reviewed this pre-hire checklist and confirm that all required background checks have been completed, results have been reviewed, and evidence of all background checks is retained in the applicant's personnel file. I understand that no start date shall be set until this checklist is fully completed and signed. I authorize the applicant to begin employment on the proposed start date listed above, contingent upon all items above being verified complete.
HR Representative Name
HR Signature
Date: 2026-10-28
Hiring Manager Name
Hiring Manager Signature
Date: 2026-10-28
Dulla Care Home Healthcare · Pre-Hire Background Check Checklist · OAC 173-39-02.12 · Confidential