ACHD Certification Submission

Please complete all requirements below. If you need to save and come back to this form you will be able to have a link created to return to your submission by clicking "Save and Continue Later".

Certification

Step 1 of 5

Name*
Email*
District*
Transparency
Completion of Ethics Training*
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Max. file size: 256 MB.
Provide copies of AB 1234 Training Certificates for all Trustees and Executives.
Completion of Sexual Harassment Prevention Training*
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Max. file size: 256 MB.
Provide copies of Sexual Harassment Prevention Training Certificates for all Trustees and Executives and a policy for all nonsupervisory employees to receive their mandated training
Ralph M. Brown Act*
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Max. file size: 256 MB.
Provide a copy of the Board’s Policy on the Brown Act.
Public Records Request*
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Max. file size: 256 MB.
Provide a copy of the Board’s Policy on public records requests.
Conflict-of-Interest Policy*
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Max. file size: 256 MB.
Provide a copy of the Board’s conflict of interest policy
Fair Political Practices Commission required filers*
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Max. file size: 256 MB.
Provide a list of all designated Form 700 filers for your District.
State Controller’s Compensation Report*
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Max. file size: 256 MB.
Please provide a copy of the report submitted to the State Controller’s Office.
Grant Policy*
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Max. file size: 256 MB.
Provide a copy of the District’s most recently adopted grant policy.

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Website Content
Please provide links to the following sections of your website.
District's Mission Statement*
Map of District Boundaries*
ACHD's definition of a Healthcare District*
Link to ACHD.org on District website*
Trustee, Manager, Staff Contact Information and Board Biographies*
Board Meeting Information on District Homepage*
Webpage with 12 months on Board Meeting information*
Enterprise Systems Catalog*
Programs and Services Offered*
Annual Operating Budget*
Financial Audits*
District Election/Vacancy Process*
Link to Healthcare District Authorizing Statute on District Website*
Recipients of Grant Funding*
Municipal Services Review*
Link to your District's State Controllers Financial Report on the District’s website.*
AB 1234 Ethics Certificate for all Trustees and Executives*
Reimbursement Policy*
Compensation Policy*
Public Records Request Form*
Financial Reserves Policy*
District Bylaws*
Mobile Friendly Website (Link to the District’s homepage)*
Website Transparency*
- Annual Utilization Report
- Annual Services Report
- Patient Demographics reports
- Quality Reports
- Annual Report
- Hospital License
Must post one or more.
Annual Utilization Report*
Annual Services Report*
Patient Demographics reports*
Quality Reports*
Annual Report*
Hospital License*

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Best Practices
CEO Evaluation*
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Max. file size: 256 MB.
Provide a copy of the most recent annual evaluation of the CEO. For renewal applications, Districts must provide three years of documentation relating to the annual evaluation of the CEO.
Board Self Evaluation*
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Max. file size: 256 MB.
Provide three years of documentation relating to the annual evaluation of the Board.
Job Descriptions for Officers of the Board*
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Max. file size: 256 MB.
Provide a copy of the roles and responsibilities of officers.
Please provide at least three of the following…*
- Copy of most recent Strategic Plan
- Community Messaging
- Community Engagement
- Annual Budget Hearing
- Link to audio/video recordings of board meetings on website
- Demonstrate Board Continuing Education
Copy of most recent Strategic Plan*
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Max. file size: 256 MB.
Community Messaging*
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Max. file size: 256 MB.
Community Engagement*
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Max. file size: 256 MB.
Annual Budget Hearing*
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Max. file size: 256 MB.
Link to audio/video recordings of board meetings on website*
Demonstrate Board Continuing Education*
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Max. file size: 256 MB.

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ACHD Certification Submission

Certification

Step 1 of 5

Transparency

Website Content

Executive Compensation

State and Local Agency Reporting

Financial

Best Practices