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THIS SECTION TO BE COMPLETED BY EMPLOYER. This physical examination is for the purpose of employment in a child care facility. The types of activities this individual will be doing are as follows (please check all that apply):
Questions about your PA Child Abuse Clearance application? Call ChildLine 1-877-371-5422. You can now submit your your Child Abuse History Clearance request online.
I authorize the child care staff and my child’s health professional to communicate directly if needed to clarify information on this form about my child. This form may be updated by a health professional. Initial and date any new data. The child care facility needs a copy of the form.
THIS SECTION TO BE COMPLETED BY EMPLOYER. This physical examination is for the purpose of employment in a child care facility. The types of activities this individual will be doing are as follows (please check all that apply):
child care staff health assessment (55 Pa. Code §§3270.151, 3280.151 and 3290.151) This physical examination is for the purpose of employment in a child care facility.
For links to child care regulations, forms, contact information, orientation schedules and other important information, visit the Pennsylvania Department of Human Services (DHS) website. Contact The Bureau of Certification Services
STAFF HEALTH ASSESSMENT. 3270.151, 3280.151, 3290.151. CHILD DAY CARE CENTERS. • GROUP DAY CARE HOMES •. FAMILY DAY CARE HOMES. NAME OF PERSON EXAMINED. DID YOU CONDUCT A PHYSICAL EXAMINATION?