Reviewed by:
_________________________________Director/Owner
_________________________________Health Professional (physician, nurse,
health department, EMS, Health consultant)
_________________________________Staff member
_________________________________ Other (parent, advisory committee)
Effective Date and Review Date:
This policy is effective ___________________________ (date) and
Reviewed yearly__________________________________ (date) or as needed.
*This format is adapted from and used with permission of: National Training Institute for Child Care Health
Consultants, UNC, 2000