Suspected Illness or Communicable Disease Exclusion Form (PDF; 131KB; 1p) Revised!
Formulario de exclusión por
sospecha de enfermedad o de (PDF; 132KB;1p) New!
Communicating with parents about health concerns at child care is an important step in caring for an ill child. This form will help you report your observations to parents. It includes a list of signs and symptoms that indicate a need for medical attention.
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CCHP Health and Safety Checklist--Revised
The CCHP Health and Safety Checklist-Revised is an 82-item observational measure that was developed to: 1) assess the health and safety status in early care and education (ECE) programs, 2) assess compliance with key National Health and Safety Performance Standards (American Academy of Pediatrics, American Public Health Association and National Resource Center for Health and Safety in Child Care, 2002), and 3) assist users to develop interventions to address the health and safety needs identified on the CCHP H&S Checklist.
The CCHP H&S Checklist was modified from the original CCHP Health and Safety Checklist based on several years of researchers' and Child Care Health Consultants' experiences using the measure. In addition, the new Health and Safety Checklist was modified to be more user-friendly, comprehensive and better organized than the original CCHP Health and Safety Checklist. An advisory group of experts met to review and prioritize the items. Each checklist item is cross-referenced with National Standards and California State Licensing Regulations.
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The CCHP Health and Safety Checklist Summary is designed to be completed after a health and safety assessment in an early care and education program is conducted using the CCHP Health and Safety Checklist-Revised. The Summary Form is organized by subscale and there are three columns to complete for each subscale: # of standards (items) which meet the National Standards, # of standards (items) which do NOT meet the National Standards, and action steps needed to meet the National Standards.
The last row is for the overall summary of the total # of items that meet the National Standards and total # of items that do NOT meet the National Standards. Lastly, there is a space to write notes and recommendations along with the date of the next assessment.
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CCHP Health and Safety Policies Checklist
The California Childcare Health Program Health and Safety Policies Checklist (2005) was developed to objectively assess written health and safety policies in early care and education programs. The Checklist can be used by child care providers or directors, child care health advocates, child care health consultants, health professionals, and researchers. It assesses the quality of written health and safety policies and helps child care and health professionals identify how to improve written policies and target interventions. The Checklist is based on the University of North Carolina of Chapel Hills's Quality Enhancement Project and the National Health and Safety Performance Standards (AAP, APHA, NRC, 2002).
CCHP Health and Safety Policies Checklist (PDF; 193KB; 13pp)
Safe Sleep policy for Infants in Child Care (PDF;180KB;2pp) NEW!
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Infant/Toddler (birth to 36 months) Development and Routine (PDF; 45KB; 1p)
As a basis for meeting a child's health, behavioral and social needs in the child care setting, the file for each child should include a history form that is completed by the parent/guardian upon admission, preferably with assistance from the staff. This form addresses issues relevant to infants and toddlers only.
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Information Exchange on Children with Health Concerns (PDF; 64KB; 1p)
Working with a parent/guardian, a child care provider can obtain relevant information on a child's health and development from the child's health care provider in an effort to better understand and address the child's unique needs. This form authorizes the exchange of information. It is completed by the child care provider and signed by the parents, giving consent for release of such information from the health care provider to the child care provider.
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Injury Report Form (PDF; 26KB; 1p)
It is important that all child care programs record any injury that requires first aid, such as a bandage or a cold compress. Planning for injuries, reporting injuries and eliminating hazards or conditions that cause injuries should be part of the overall plan to keep children safe while they are in child care. And by tracking injuries that happen, programs can look for patterns caused by hazardous conditions and identify problem areas before they cause serious injury. This form is to be used to ensure accurate tracking and appropriate follow-up of all serious incidents that occur in child care.
This form was developed by CCHP staff and is excerpted from Health and Safety in the Child Care Setting: Prevention of Injuries, A Curriculum for the Training of Child Care Providers, 2nd Ed.
If you discover a child's injury, such as bruising, cuts or burns, and suspect child abuse, you are required to file a report with your local child protective services agency.
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Insect Repellent Consent (PDF; 37KB; 1p)
Due to the presence of chemicals and the possibility of allergic reactions for some children exposed to insect repellents, this form provides parental consent to apply insect repellent while in the child care setting.
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Liability Exposure and Child Care Health Consultation (PDF; 105KB; 1p)
Child care health consultation is a new profession emerging out of an identified need to link the public health and child care fields together. As of yet, there exists no definitive consensus on the scope of this work or the standards of care that are expected of those who engage in the work. This document describes the most significant methods available for minimizing liability exposure in California.
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Medication Administration Form (PDF; 136KB; 2pp) Revised!
Formulario de administración de
medicamentos (PDF; 138;2pp) New!
Child care programs must have a written policy for the use of any medication (prescription and nonprescription) that the facility keeps on hand to use with parental consent. This form documents such authorization of administration of medication for a child while in care. The reverse side of the form is a monthly medication log that allows the monitoring and tracking of medication dispensation.
For additional information about medication administration health policies, procedures and training see Caring for Our Children: National Health and Safety Standards: Guidelines for Out-of-Home Child Care Programs and/or contact the Healthline at (800) 333-3212 (California Only).
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Notice of Exposure to Communicable Disease (PDF; 127KB; 1p) Revised!
This form will help you prepare a written notice to parents about their children's exposure to communicable disease. The notice will alert them to watch for signs and symptoms of the illness while maintaining confidentiality of the child or staff member who has the disease.
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Nutrition and Feeding Care Plan (PDF; 39KB; 2pp)
The development and implementation of a care plan for a child with feeding and/or nutritional issues should be determined by each child's unique needs. This form defines all members of the child's care team; specifies the communication approaches of the team members; details the strategies for appropriately caring for the child with special dietary and/or feeding concerns in group care settings, and identifies accommodations/modifications necessary while the child is in care.
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Preschool (3-5 years) Development and Routine (PDF; 44KB; 2pp)
As a basis for meeting a child's health, behavioral and social needs in the child care setting, the file for each child in care should include a history form completed by the parents/guardian upon admission, preferably with staff involvement. This form addresses issues relevant to preschoolers only.
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Quality Inclusive Child Care Checklist (PDF; 192KB; 2pp)
Quality care provides a safe and healthy learning environment that supports the social, physical, intellectual, creative and emotional development of all children. This checklist assists parents of children with disabilities or special needs in looking, listening and asking questions in the process of selecting the child care setting that best meets the needs of their child and family. It can also assist programs in identifying the necessary components of a quality inclusive child care setting as they evaluate their program and services provided.
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Seizure Care Plan & Seizure Activity Log (PDF; 32KB; 3pp)
The development and implementation of a care plan for a child with a seizure disorder should be determined by each child's unique needs. This form defines all members of the child's care team; specifies the communication approaches of the team members; details the strategies for caring for a child who has had seizures, and how to meet his/her needs while in group care settings, and contains a seizure activity tracking log for while the child is in care.
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Special Health Care Plan (PDF; 36KB; 3pp)
The development and implementation of a care plan for a child with special health care needs should be determined by each child's unique needs. This form identifies all members of the child's care team; specifies the communication approaches of the team members; details the strategies for appropriately caring for the child with special health concerns in group care settings, and identifies accommodations/modifications necessary while the child is in care.
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Sun-Smart Policy (PDF; 44KB; 1p)
This policy ensures that all children and staff participating in a child care program are protected from skin damage caused by the harmful UVB and UVA rays of the sun throughout the year. On the reverse side is a parental consent form for permission to apply sunscreen while in the child care setting.
The policy was developed by CCHP; the consent portion was adapted from the California Early Childhood Sun Protection Curriculum.
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Toy Safety Checklist (PDF; 20KB; 1p)
Use this checklist to help keep children safe while using the learning equipment and materials provided in the child care settings.
This form was developed by CCHP staff and is excerpted from Health and Safety in the Child Care Setting: Prevention of Injuries, A Curriculum for the Training of Child Care Providers, 2nd Ed.
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