Purpose: To examine issues related to the condition, cost, and future use of each facility, and to explore other site options. Be sure that you have provided enough information to enable the Head Start program to set priorities and to decide which improvements should be made immediately, which should be made over the next year, which should be scheduled for the future, and which can be deferred indefinitely.

Instructions: Complete the form below by describing each needed improvement in each facility. Be specific. Include a justification for the improvement (for example, needed to meet licensing; compliance with Head Start Performance Standards) and include cost data. Attach additional sheets to the form as necessary.

Name of Program: ________________________________________________________

Location of Center Being Assessed: ___________________________________________

Person(s) conducting assessment: ___________________________________________

Date of assessment: _____________________________

Ownership of building (if leased, when does lease expire?) __________________________

Assessment Step:	Name of Facility: __________________
1. Capacity of building Number and type (or function) of rooms. [Describe the building's rooms and the use to which the rooms are or can be put]. Outdoor space and how it is currently used. # of children currently served in building # of staff currently using office space # other current uses of building
2. Program quality How does this facility affect program quality; better or worse? [Refer to Performance Standards and state how the building helps or hinders in meeting the Performance Standards.]
3. Condition of building and grounds: Analyze any problems in the following areas and include an estimate of the cost of repair: Playground Plumbing Roof Kitchen Floor Heating system Fire safety Electrical system Other (specify)
4. Cost effectiveness of necessary renovation: Analyze cost effectiveness of necessary renovations. Write a timetable for the renovations, listing them in descending order of priority. (What needs to be done right away? What can be deferred?)
5. Future use of the building: Is it in the best interests of the program to continue to occupy the building? Why or why not? Is expansion of this building to increase its total area possible? Desirable?
6. Other site options What other site options are available? (Rental, purchase, construction)

Additional comments: (Attach additional sheet if necessary.)