Child Care Center/group Inspection Form

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Department of Public Health-Child Care Licensing Program
Page 1 of 2
Operating
410 Capitol Ave, MS #12 DAC
Days
PO Box 340308
Hartford, CT 06134-0308
800-282-6063/(fax) 860-509-7541
CHILD CARE CENTER/GROUP INSPECTION FORM
INITIAL INSPECTION
INSPECTION
FOLLOW UP
OTHER
Program Name:
License Number:
Date of
Time of
Inspection:
Arrival:
Address:
Expiration Date:
Licensed
Capacity:
Town:
Telephone:
Under Three
Endorsement:
Operator:
Licensed For:
Instructions:
= Compliance
Number of Children Number of U3
Number of Staff
Under Three (6wks-36m)
O
= Non-Compliance
Present:
Present:
Present:
Preschool (3y-5y)
3
= Not Observed
Hours of Operation:
Summer Care
School Age (5y&up)
4
= Not Applicable
Yes/No
Night Care (6wks&up)
Licensure Procedures 19a-79-2a
Health and Safety 19a-79-6a
1. Local Health Inspection
Date: ____________
40. Nutritious Snacks/Meals (Required Food Groups)
Administration 19a-79-3a
41. Proper Refrigeration 45°
2. New Staff/Employee Orientation
42. Kitchen Separated
3. Annual Staff Training
43. Hand Washing Before Eating/Food Handling
4. Documentation of Beh M. Tech Discussed w/Parents Y/N
44. First Aid Kit(s): Indoor/Outdoor/Field Trip
5. Notification of Change
Physical Plant 19a-79-7a
6. Policies: Discipline/Supervision/Child Protection/General
45. License Premise Clean/Good Repair/Safe
Operating Policies/Personnel Policies/Closing Time Policy
46. Peeling Paint Observed: Y/N, Sample Taken: Y/N
7. Daily Attendance Records: Children/Staff
47. Lead Management Plan Reviewed: Y/N
Items Posted: Conspicuous/Accessible
48. Sanitary Drinking Fountains/Disposable Cups
8. License
49. Lead Water Test
Date:________________
9. Current Fire Marshal Certificate Date:____________
Within Acceptable Limits Y/N
10. DPH Complaint Procedure
On Bottled Water Y/N
11. Food Service Certificate Date:____________
50. Walkways Maintained
12. Menus
51. Designated Staff Toilet/Sink
13. Emergency Plans
52. All Openings for Ventilation Screened
14. No Smoking Signs
53. Windows Protected to Prevent Falls
15. Radon Test
Date:_________ Results:___________
54. Glass Protected to 36”
Staffing 19a-79-4a
55. Overhead Doors: Locking Devices/Spring Protectors
16. Staff Health Records
56. Exits/Hallways and Stairs Unobstructed
17. Professional Development
57. Individual Storage of Clothing/Bedding
18. Disciplinary Actions
58. Smoking Prohibited
19. Designated Head Teacher/60%
59. Matches/Lighters Inaccessible
20. Two Staff Present
60. Approved Safety Outlets/Covers
21. Ratio: 1 Staff to 10 Children
61. Toileting Needs Met
22. Group Size: Maximum 20 Children
62. Required Toilets/Sinks/Supplies
23. Designated Director
63. Potty Chairs: Nonporous/Emptied/Disinfected
24. CPR Certified Staff
64. Hand Washing After Toileting: Staff/Children
25. First Aid Trained Staff
65. Ventilation in Toilet Room
Consultants 19a-79-4a
66. Air Temp 65°, Thermometer Affixed
26. Agreements/Contracts ( Signed Annually)
67. Water Temperature 60°-115°
27. Logs/Visits Documented
68. Portable Space Heaters Y/N
Early Ch. Education____ Health___ Dental_____
69. Walls/Ceilings/Floors/Rugs: Clean/Good Repair
Social Service___ Dietitian___
70. Rugs Secured
Swimming 19a-79-4a
71. Hot Water/Steam Pipes Protected
28. Non-Swimmers Identified
72. Working Phone on Each Level
29. Staff/Child Ratios
73. Emergency Numbers Posted
30. CPR Certified Staff (20 years of age)
74. Adequate Lighting: 50/30 Candle Feet
31. Lifeguard Certified/Supervision
75. Light Fixtures Shielded/Shatter Proof
Record Keeping 19a-79-5a
76. Potentially Hazardous Substances Locked
32. Enrollment Information
77. Garbage/Rubbish Disposed Daily
33. Emergency Medical Permission
78. Stairs Protected/Good Repair/Handrails
34. Authorized Released Permission
79. Pets: Maintained/Care Plan
35. Field Trip Permission
80. Operable CO Detector on Each Level
36. Transportation Permission
81. Program Space/Adequate Sq. Ft. Per Child
37. Child Health Records/Immunizations/TB
82. Equipment Clean/Good Repair/Safe/Non-toxic
38. Individual Care Plan (Signed by Parent/Staff)
83. Cots Stored/Maintained/Adequate Number
39. Injury/Illness/Accident Reports
84. Developmentally Appr. Equipment/Materials
Signature of Inspector
Written Corrective Action Plan
Signature of Person in Charge
Due to DPH by:

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