Forms, Policies, and Checklists

Child Care Health Consultants engage in a variety of activities and each presents a possibility of liability exposure. Based on general legal principles and experience, some types of activities pose a greater degree of exposure than others. This list in this document will provide consultants with a sense of relative exposure resulting from the varied activities in which they might engage.

The Child Care Evaluation Worksheet can be used by researchers, child care providers, or anyone interested in assessing a child care program for health and safety. Record reviews are valuable because they indicate areas in need for individual children as well as the group (such as immunization gaps or medical homes). Please note that review of children's health records in a child care setting by outside observers requires individual parent consent in California.

The Child Care Evaluation Worksheet was developed by the University of North Carolina, Quality Enhancement Project.

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.

This form provides parental permission for a child and/or family to receive health consultation services such as assessments, observations, screenings and consultations that will be provided onsite at the child care setting. It also permits sharing of the information between the child care staff and the health professional for the purpose of understanding and addressing the child's or family's needs.

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

Child care facilities should have a health professional with experience and training in child care, known as a Child Care Health Consultant (CCHC), affiliated with their program. This form requests legal permission for CCHCs to review individual health records of child care providers/staff.

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

This form provides parental permission for the exchange of relevant health, development and/or educational information between a 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. This form is for use in situations where there is not a referral to services.

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

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.

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.