Forms, Policies, and Checklists

Sample Infant Sleep Observation Form

This form can be used to document that a provider has checked on a sleeping infant every 15 minutes, in compliance with the Child Care Licensing requirements for a safe infant sleeping environment in both Child Care Centers and Family Child Care Homes.

Sample Nutrition Policy

Sample COVID-19 Pandemic Policy

Sample Physical Activity Policy

Sample Green Cleaning Policy

Sample IPM Policy for ECE

The California Childcare Health Program has developed these sample forms, policies, and checklists for use by providers in child care programs. You can find forms, policies, and checklists related to disaster preparedness on the Disaster Preparedness Page.

IPM Checklist

IPM Policy for Family Child Care Homes

Consent for Release of Information and Referral

This form provides parental permission for the release of health, development and/or educational information between the Child Care Health Consultant (CCHC), the child care program staff and other individuals, programs or agencies that are working with the child and family in an effort to better understand and address their needs. In addition, this form obtains parental permission for the referral to needed support services for the child and/or family.

This form was developed through a collaboration between Abby J. Cohen, J.D. and CCHP.

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Forms, Policies, and Checklists

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