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Attachment #4, 9.01 4 of 9

Is EBT equipment kept secure?

Who in the clinic approves WIC-53 forms?

When there is not a Competent Professional Authority (CPA) onsite, how are WIC-53 and food package changes handled?

Are comment forms readily available to participants in the waiting room or prominent location?

Facility Evaluation

Is WIC in its own building or does the clinic share space with other entities? If shared, what other entities share the facility?

Is participant confidentiality protected by providing private areas for breastfeeding, intake, medical history and nutrition counseling?

Are WIC offices separated by lockable doors? Who has keys to the clinic? Who is responsible for locking WIC office?

Is the building clean, safe, and does it have adequate space?

Are participant areas safe for children?

If laptops are used in the clinic, where are they stored when not in use? Do they ever leave the clinic, and if so, for what reasons?