Monthly Crib Safety Inspection Form And Monthly Fire And Storm Log (Page 2 of 3) in pdf

Monthly Crib Safety Inspection Form And Monthly Fire And Storm Log Page 2

MONTHLY FIRE AND STORM LOG

Fire Drill Meeting Place (Monthly):_____________________

Storm Drill Meeting Place (Monthly):________________________

Month

January

February

March

April

May

June

July

August

September

October

November

December

Fire Drill

Storm

Drill

Smoke

Detectors

ANNUAL CERTIFICATION OF CRIB

checked the crib’s brand name

On ______________________

, I ____________________________________________

(date)

(name and title)

and model number listed on Page 1 against the U.S. Consumer Product Safety Commission Web site listing unsafe cribs. ( )

The crib was not identified as unsafe on the U.S. Consumer Product Safety Commission Web site.

The crib was identified as unsafe on the U.S. Consumer Product Safety Commission Web site, but I have taken the action

directed by the United States Consumer Product Safety Commission to make the crib safe. (Identify all actions taken.)

The crib was identified as unsafe on the U.S. Consumer Product Safety Commission Web site, and I have removed the crib

_________________________

so that the crib is no longer used by or accessible to children in care.

(date)

Maintain this document on site and make it available to parents of children in care and the commissioner upon request.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

MONTHLY SAFETY INSPECTION DOCUMENTATION

(Action(s) taken regarding unsafe cribs during the monthly crib safety inspections.)

_______________________________________________________________________________________________________________

_________________________________________________________________________

Requirements: Minnesota Statutes, section 245A.146

February 2015

Monthly Crib Safety Inspection Form And Monthly Fire And Storm Log Page 2