Forms, Policies, and Checklists

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.

Use the  menu at the top of the table to select forms, policies, or checklists in a particular topic area, for example: injuries or children with special health needs or disabilities.

Browse Forms, Policies, and Checklists

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CCHP Health and Safety Checklist (pdf; 1.33 MB) Lista de verificación de salud y seguridad para el cuidado y la educación a temprana edad (pdf; 1.29 MB)
早期護理和教育健康和安全檢查清單
(pdf; 2.46 MB)
CCHP Health and Safety Checklist Summary (pdf; 457.61 KB)
CCHP Health and Safety Checklist User's Manual (pdf; 1.42 MB)
CCHP Health and Safety Policies Checklist (pdf; 230.72 KB)
Consent for Exchange of Information (pdf; 431.19 KB)
Consent for Release of Information and Referral (pdf; 137.01 KB)
Consent for Review of Staff Health Records (pdf; 431.89 KB)
Consent for Services (pdf; 463.84 KB)
Continuum of Liability Exposure for CCHCs (pdf; 79.01 KB)
COVID-19 Pandemic Sample Policy (docx; 25.77 KB)
Infant/Toddler (birth to 36 months) Development and Routine (pdf; 138.12 KB)
Information Exchange on Children with Health Concerns (pdf; 149.87 KB)
Injury Report Form (pdf; 52.05 KB) Formulario de informe de lesiones (pdf; 65.39 KB)
受傷報告表格
(pdf; 376.56 KB)
Insect Repellent Consent (pdf; 62.18 KB) Permiso de padres o tutores para aplicar repelente de insectos al niño (pdf; 113.84 KB)
IPM Checklist (pdf; 717.72 KB) Lista de Control de IPM (pdf; 1.05 MB)
IPM Policy for ECE (pdf; 29.37 KB) Política de Manejo Integrado de Plagas (IPM) Para Centros de Cuidado Infantil (pdf; 408.71 KB)
IPM Policy for Family Child Care Homes (pdf; 131.48 KB) Política para las casas de cuidado infantil hogareño (pdf; 48.68 KB)
Liability Exposure and Child Care Health Consultation (pdf; 76.03 KB)
Medication Administration Form (pdf; 129.23 KB) Formulario de administración de medicamentos (pdf; 102.73 KB)
Model Policy for Green Cleaning, Sanitizing, and Disinfecting in Child Care Programs (pdf; 34.29 KB) Limpieza Ecológica, Higienización y Desinfección en Programas de Cuidado Infantil (pdf; 414.6 KB)

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