Documents, Forms, and Policies

Shaken Baby*

Shaken Baby Abusive Head Trauma Policy Sample [DOC]| Prevención del Síndrome de Bebé Sacudido (Shaken Baby Syndrome, SBS) y el Trauma Craneal por Maltrato (Abusive Head Trauma, AHT) Muestra [DOC]

Children’s Medical Report [PDF]| Reporte Medico para Niños [PDF]

Confidentiality Policy Sample [DOC]

Notification of Facility working with a Child Care Health Consultant [DOC]

Emergency Drill Log Centers [PDF]

Emergency Drill Log FCCH [PDF]

Hazardous Item Storage

Hazardous Item Storage [PDF]| Almacenamiento de artículos peligrosos para guarderías [PDF]

Tobacco Free

Tobacco Free Child Care Center Policy Sample [DOC]| Normas de prohibición total de consumo de productos del tabaco en establecimientos de cuidado infantil Muestra [DOC]

Tobacco Free Child Care Family Child Care Home Policy Sample [DOC]| Normas de prohibición total de consumo de productos del tabaco en hogar de cuidado infantil familiar de cuidado infantil Muestra [DOC]

Tobacco free poster [PDF]| Libre de Tobaco [PDF]

NC Child Care Immunization Policy Sample [DOC]

Child Immunization History [PDF]

Sample confirmation form that a child can safely return to child care [DOC]

Sample notification of exposure to communicable disease [DOC] – See Communicable Diseases and Exclusion from Child Care chart [HTML].

Medical Action Plans | Planes de Acción Médica

Allergy and Anaphylaxis (non-food) [PDF]

Allergy and Anaphylaxis (food) [PDF]| Plan de Atención de Emergencias de Alergias Alimentarias y Anafilaxia [PDF]

Child Care Diabetes Medical Management Plan [PDF]

Medical Action Plan: Asthma [PDF]| Plan de Acción Médico: Asma [PDF]

Medical Action Plan: General [PDF]| Plan de Acción Médico del Niño [PDF]

Seizure Action Plan [PDF]| Plan de Acción para Crisis Epilépticas [PDF]

Medication Administration Forms | Formularios de Administración de Medicamentos

Medication Error Report [PDF]| Informe de Errores con Medicamentos [PDF]

Medication Administration Permission and Record [PDF]| Formulario de Permiso para la Administración de Medicamentos [PDF]

Medication Administration Permission – topical ointments, etc [PDF]| Formulario de Autorización para la Administración de Medicamentos de Uso Tópico sin Receta, etc. [PDF]

Policy

NC Medication Administration Policy Sample [DOC]

Note: Before implementing a medication administration policy or using these forms, contact a local CCHC for training and technical assistance.

Family Provided Milk Substitution Permission Form Sample [DOC] – updated 11/29/2023

Child Care Toothbrushing Policy Sample [DOC]| Normas de cepillado dental en establecimientos de cuidado infantil Muestra [DOC]

Safe Sleep*

Infant Toddler Safe Sleep Policy Sample [DOC]| Normas de seguridad del sueño de bebés y niños pequeños Muestra [DOC]

Alternative Sleep Position Health Care Professional Waiver [PDF]| Autorización ITS-SIDS de profesionales médicos Posturas alternativas para dormir/uso de cuñas [PDF]

Alternative Sleep Position Parent Waiver [PDF]| Autorización ITS-SIDS de los padres Posturas alternativas para dormir [PDF]

Staff Health Assessment/Medical Report [PDF]

Tuberculosis Screening or Test Record [PDF]