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- Behavioral Data Collection Sheet
A form that helps early education providers document for parents and health professionls observations of the child. This documentation facilitates communication when there are concerns about a child's behavior. - Care Plan for a Child with Special Needs in Child Care
When children with special needs are in group care, information should be shared by parents and the child’s primary health care provider (PCP) with those who care for him/her. This Care Plan is used to communicate information to child care practitioners who are non-medical professionals. Child care practitioners should make sure they understand the information and obtain any training necessary. Children with special needs will require the completion of the parts of this Care Plan that document their daily or emergency needs. Additional information may be required for some children. The supplemental forms referred to in the Care Plan can be found in the “Forms” section of the ECELS website. For an explanation of each of the parts of the Care Plan, click here.8/30/12
- CY-47 Form: Report of Suspected Child Abuse
PA Department of Public Welfare’s form for mandated reporters to document information about suspected child abuse and neglect. Mandated reporters call ChildLine at 800/932-0313 to report suspected abuse and submit this completed form within 48 hours to the county children and youth agency. For more information and professional development on child abuse and neglect, see the online ECELS Child Abuse and Neglect Self-Learning Module. 5/24/12 - Emergency Information Form for Children with Special Health Care Needs
This hyperlink is to a form that is posted on the website of the American Academy of Pediatrics. The form records health information for children with special health care needs. It can also be used to prepare for emergencies so that a child's medical history, medications, and treatments are accessible to emergency services personnel. - Family Child Care Home Health and Safety Checklist
This Health and Safety Checklist for Home-based (Family Child Care Home) providers is a quality improvement tool. Sharing the checklist with families of children in child care is likely to help them appreciate what their child’s caregiver is doing to keep their children safe. Parents/legal guardians may want to use the checklist to see how to make their own homes safer for their children. They may offer to help make the improvements the home-based child care facility needs. We suggest each home-based provider use the checklist every 6 months or so to see what is still needed and what improvements can be made. 2/11/2013. - Health and Safety Action Plan
A form to guide collaborative problem-solving involving those who are affected, those with authority, and those with expertise. The form encourages documentation of who is involved, the tasks planned, who is responsible, and checkpoints for follow-up. - Health and Safety Action Plan - Sample (Biting)
A typical action plan using biting as the focus of problem-solving - Incident Report Form
 This is a 2012 version of a form originally published in Model Child Care Health Policies. Use the form to document injuries and unusual incidents in group care programs for children. Periodic review of the information recorded on the form will help identify targets for preventive measures. Click here for the Incident Report Form. 1/10/12 - Special Care Plan for A Child with Behavioral Problems
This sheet is intended to be used by health care providers and other professionals to formulate a plan of care for children with severe behavior prblems that parents and child care providers can agree upon and follow consistently.
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