DSP Training QR4100

REVISED 09/11/23

Provider/Agency Name:

Program: _ ISC _ CILA _ HBS _ CDS _ SDA _ CRW _ CSW

Date(s) of Review:

Reviewer(s):

Item	E	E	E	E	E	E	E	E
DSP Employee Initials
Date of Hire: Avoid selection of DSPs who have not completed training if possible.
1. Was the DSP trained prior to hire at this agency? (If yes skip to Question 6)	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
2. Has the DSP completed a DHS approved DSP training program with a minimum of 40 hours classroom and 80 hours on the job training? (If N/A skip to Question 6)	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
3. Did the DSP complete the DSP training in no less than 3 weeks?	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
4. Did the DSP complete the training within 120 days of hire (first day in paid status)?	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
5. Was the DSP added to the IDPH Health Care Worker Registry within 30 calendar days of successfully completing the DSP training?	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
6. Does the DSP have American Heart Assoc. or American Red Cross CPR/First aid certification?	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No	_ Yes _ No
7. Has the DSP received training on crisis de-escalation, trauma informed practices, behavior management practices, and alternatives to the use of restraint? (Training can be agency developed or from a third party: CPI, Mandt, etc. - training sign-in sheets are sufficient proof.) (supplement to PMG6) (no findings associated with this question)	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate	_ Yes _ No Date of initial or most recent training certificate
8. Remediation required?
9. Item for Remediation
10. Comments

Excerpt from the Program Manual, Attachment A:

The Provider is required to maintain all training records for DSPs at the Provider's administrative office. This includes the DSP Training Program Competency Area Checklist, sign-in sheets verifying attendance in the classroom training, and all On-the-Job Training Activities (OJTs) and Competency-Based Training Assessments (CBTAs).

AHA/ARC CPR/First Aid Certifications are valid for 2 years from date of issue through the last day of the expiration month.

DSP Training Requirements and Training Extension Waiver:

IDHS: Direct Support Person (DSP) (state.il.us)

IDHS: DSP Required Record Keeping (state.il.us)

IDHS: DSP Waiver for Delay in Meeting Training Requirements (state.il.us)

IDHS: COVID-19 DSP Training (state.il.us)