nw michigan community action agency · *before and after playing in the water that is shared by two...

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Page 1 of 35 7/31/2019 2:18 PM khagen NW Michigan Community Action Agency 2019-20 Head Start Safe Environments Checklist 8020 - Monitoring Worksheet Due: Actual: Scheduled: Licensee 1.1 Non-Compliant Not Applicable Not Observed Compliant Notes: The current license and if applicable, the letter extending the license beyond the expiration date is in a place accessible and visible to parents. 1.2 Non-Compliant Not Applicable Not Observed Compliant Notes: Current child care center rules and any variances granted are in a place accessible and visible to parents. 1.3 Non-Compliant Not Applicable Not Observed Compliant Notes: The licensing notebook is on the premises and is available to parents/prospective parents at all times during the center's normal hours of operation. The licensing notebook will be maintained and retained on site until the license closes. 1.5 Non-Compliant Not Applicable Not Observed Compliant Notes: A sign-in/sign-out system is used to track visitors who enter and exit the classroom. 1.4 Non-Compliant Not Applicable Not Observed Compliant Notes: Center maintains licensed capacity and age range. Only space that has received prior approval for child use by licensing may be used for child care. © ChildPlus

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Page 1: NW Michigan Community Action Agency · *Before and after playing in the water that is shared by two or more people ... When the cleanup of bodily fluids (urine, feces, blood, saliva,

Page 1 of 357/31/2019

2:18 PM khagenNW Michigan Community Action Agency

2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Due:

Actual:

Scheduled:

Licensee

1.1 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

The current license and if applicable, the letter extendingthe license beyond the expiration date is in a placeaccessible and visible to parents.

1.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Current child care center rules and any variances grantedare in a place accessible and visible to parents.

1.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The licensing notebook is on the premises and is availableto parents/prospective parents at all times during thecenter's normal hours of operation. The licensingnotebook will be maintained and retained on site until thelicense closes.

1.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A sign-in/sign-out system is used to track visitors whoenter and exit the classroom.

1.4 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Center maintains licensed capacity and age range. Onlyspace that has received prior approval for child use bylicensing may be used for child care.

© ChildPlus

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2:18 PM khagenNW Michigan Community Action Agency

2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Licensee

1.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Smoking does not occur in the child care center, on realproperty, or on field trips.

Staff and Volunteers

2.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All staff and volunteers provide appropriate care andsupervision of children.

2.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Redundant procedures are in place to ensure that no childis left alone, i.e. a second staff person is designated tocheck the classroom, outdoor play areas, sleeping areas,and vehicles during transitions and prior to departure.

Staff will do the following:*count on a scheduled basis*count at every transition*focus on the placement of staff while walking in a line withchildren*make sure that each staff member can state the numberof children in their care at all times*count out loud and communicate the count to other staffmembers*adapt supervision strategies for individual children basedon their needs*count when leaving one area and count again whenarriving at another*maintain vigilance at all times.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Hand washing

3.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Staff, volunteers, and children must wash hands:

*Upon arrival for the day and after breaks*When hands are soiled*Before and after eating, preparing and serving food andbeverage, and feeding children*Before and after brushing or helping a child brush teeth*Before and after playing in the water that is shared by twoor more people*Before and after each diapering*After toilet use or helping a child use the toilet*After handling any raw food that requires cooking, e.g.,meat, eggs, poultry*After handling body fluids*After handling pets, pet cages, or other pet objects*After playing in sand, on wooden play sets, and outdoors

Staff and volunteers must also wash their hands:

*Prior to the care of children*Before and after giving medication or applying a medicalointment or cream in which a break in the skin may beencountered*After handling garbage or cleaning*After cleaning and disinfecting the diaper changingsurface*After removing nonporous (e.g., Latex) gloves used forany purpose

3.2 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Guidelines for hand washing are posted in foodpreparation areas, in toilet rooms, and by all hand washingsinks.

3.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Hand sanitizers and/or single-use wipes may only be usedas a temporary measure on outings.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Diapering; toileting; tooth brushing

4.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Diapering occurs in a designated diapering area that:

*Is physically separated from food preparation, cooking,eating, or children activity areas*Is within close proximity to a sink that is used exclusivelyfor hand washing*Has non-absorbent, smooth, easily cleanable surfaces ingood repair*Is washed, rinsed, and sanitized after each use

4.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Diapering supplies are within easy reach.

4.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A plastic-lined, tightly covered container is usedexclusively for disposable diapers and diapering suppliesand is emptied and sanitized at the end of each day.Diaper disposable containers need to be of a design thatdoes not require manually lifting the lid. (Diaper geniemeets the intent of this rule).

4.4 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Only single-use disposable wipes or other single-usecleaning cloths are used to clean a child during thediapering or toileting.

4.5 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Diapers and training pants are checked frequently andchanged when wet or soiled. Toilet training reports arecompleted after each diaper change.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Diapering; toileting; tooth brushing

4.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Guidelines for diapering are posted in diapering areas.

4.7 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Disposable gloves are used once for a specific child andare removed and disposed of immediately after eachdiaper change.

4.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Toilet learning/training is planned cooperatively the parent.

4.9 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Toothbrushes are labeled with the child's name, stored sothat they can air dry without touching any surface, andreplaced after 3 months.

Children's records

5.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

At the time of the child’s initial attendance, the center shallobtain a child information record, completed and signed bythe parent, and the center shall keep it on file andaccessible in the center.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Children's records

5.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Child information records are reviewed and updated byparents at least annually and when the center becomesaware of changes. Seperate child information records arecompleted for families that have joint custody. Emergencycare plans should be stapled to the child informationrecord. Staff bring child information records with themoutside, on field trips, and during evacuations.

5.3 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Staff maintain up-to-date child rosters and lists of theadults to whom each child is authorized to be released,including alternates in case of emergency.

5.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Children are only released to a legal guardian or writtendesignee as noted on the child information record. Staffmust check and photocopy identification (take a picture ofthe identification, if needed) when releasing a child to anyperson they do not know, even if the child recognizes theindividual. Staff must check to ensure this person's nameis on the child information record and attach a copy of theidentification to the record.

Medication; accident and illness; Universal Precaution Kit; First Aid

6.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Medication is given by an adult caregiver only.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Medication; accident and illness; Universal Precaution Kit; First Aid

6.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Emergency medications (EpiPen, inhaler) are stored outof children's reach at the site and on the bus and arequickly accessible at all times (shoud not be in lockedbox). All medications are within their dates of expiration.

6.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Medication is given or applied only with prior writtenpermission from a parent. Prescription medication has thepharmacy label indicating the physician’s name, child’sname, instructions, and name and strength of themedication, and it is given according to those instructionsunless authorized by a written order of the child’sphysician. Medication is stored under lock and key andrefrigerated if necessary.

6.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Medication is not added to a child’s bottle, beverage, orfood unless indicated on the prescription label.

6.6 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

A child too ill to remain in the group is placed in a separatearea and is cared for and supervised until the parentarrives.

6.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The center maintains a record as to the time and theamount of medication given or applied using themedication log. Completed records must be kept in thechild's file and a copy on the bus.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Medication; accident and illness; Universal Precaution Kit; First Aid

6.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A first aid kit is readily accessible to staff and securelystored in the center and bus. Staff bring the first aid kitoutside, on field trips, and during evacuations. Kits arekept out of the reach of children. Ice packs are alsoavailable.

6.7 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Classroom and bus universal precaution compliance kit isstocked with the following:

*Gloves*Absorbent material (Speedy Cleanz, Vo-ban, Red-Z)*Leak proof plastic bag with a secure tie*Paper towel*Disinfecting Agent (Germicidal Disposable Clothes,bleach)*Packaged Universal Precautions Kit*Cleaning, sanitizing, and disinfecting guidance is locatedinside the kit

6.9 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All staff working with children know where the universalprecaution and first aid kits are located.

6.10 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Education staff can find Material Safety Data Sheets(MSDS) on www.nmcaahs.com. These sheets provide in-depth information pertaining to materials used in theclassroom (ingredients, handling, storage, disposable, firstaid, etc.)

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Medication; accident and illness; Universal Precaution Kit; First Aid

6.11 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

When the cleanup of bodily fluids (urine, feces, blood,saliva, vomit, nasal discharge, eye discharge or any fluiddischarge) is necessary, nonporous gloves are worn bystaff when they come in contact with a spill.

6.12 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Illness/incident report forms are available in theclassroom, outside, on the bus, and on field trips, and theyare completed when changes are observed in a child'shealth, a child experiences accidents or injuries, or when achild is too ill to remain in the group (daily health check).

6.13 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Emergency preparedness kits are readily accessible tostaff.

Telephone Services

7.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A landline telephone is available, operable, and accessiblein the building during the hours of operation.

7.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

There is an appropriate greeting on the classroomvoicemail that includes the recruitment phone number.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Outdoor play area

8.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A center with children in attendance for 3 or morecontinuous hours per day provides daily outdoor play.

8.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

There is a shaded area to protect children from excessivesun exposure, when necessary.

8.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The outdoor play area is in a safe location and free frompests.Children in outdoor areas do not have access to unsafe orunsupervised areas (e.g. body of water, roads or parkinglots, or other hazards).

8.4 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

The outdoor play area is protected from hazards, whennecessary, by a fence or natural barrier that is at least 48inches in height.

8.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Children only use age-appropriate equipment. The agerequirement sticker is located on the equipment.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Outdoor play area

8.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

An outdoor play area and any equipment located on thecenter’s premises is maintained in a clean, safe condition,and inspected daily before use to ensure that no hazards,pollutants, and toxins are present, including, but notlimited to:

*Missing or broken parts*Protrusion of nuts and bolts*Rust and chipping of peeling paint*Sharp edges, splinters, and rough surfaces*Stability of handholds*Visible cracks*Stability of non-anchored large play equipment (e.g.,playhouses)*Wear and deterioration*Vandalism or trash

8.7 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Loose-fill surfacing material is not installed over concreteor asphalt.

8.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The depth of the loose-fill surface material is restored to itsrequired depth when moved or becomes otherwisecompromised (9 inches for wood and 6 inches for rubber).Woodchips are raked as needed to remain in compliance.

8.9 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Staff use Active Supervision and are stationed in zones(and interacting with children) around the playground toensure that all areas are in sight and that there are noblind spots. Children are supervised at all times.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Outdoor play area

8.10 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

S-hooks are pinched closed so that there is no gap orspace greater than 0.04 inches (about the thickness of adime).

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Equipment

9.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Equipment, materials, furnishings, and play areas aresturdy, safe, in good repair, and should attend to thefollowing safety hazards:

*Appropriate to the developmental needs and interests ofchildren*Child-sized or appropriately adapted for a child’s use*Easily accessible to the children*Designed to ensure Active Supervision of children at alltimes*High shelves are placed securely against the wall. Allother shelves should be low in order to ensure ActiveSupervision*Openings that could entrap a child's head or limbs*Elevated surfaces that are inadequately guarded*Lack of specified surfacing and fall zones under andaround climbable equipment*Mismatched size and design of equipment for theintended users*Insufficient spacing between equipment*Tripping hazards*Components that can pinch, sheer, or crush body tissues*Equipment that is known to be of a hazardous type*Sharp points or corners*Splinters*Protruding nails, bolts, or other parts that could entangleclothing or snag skin*Loose, rusty parts*Hazardous small parts that may become detached duringnormal use or reasonably foreseeable abuse of theequipment and that present a choking, aspiration, oringestion hazard to a child*Strangulation hazards (all cords: straps, strings, blindcords, etc.)*Flaking paint*Paint that contains lead or other hazardous materials*Tip-over hazards, such as chests, bookshelves, andtelevisions*Choking*Electrical hazards*Plastic bags that are large enough to pose a suffocationrisk.*Matches, candles, and lighters are not to be accessible tochildren*Drowning hazards*Hazards presented by windows and glass doors*Meets standards set by the Consumer Product SafetyCommission (CPSC) or the American Society for Testingand Materials, International (ASTM)

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Equipment

9.2 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

A current and accurate equipment inventory is available.(GSRP classrooms must complete an inventory ofequipment and supplies purchased with GSRP funds).

9.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Trampolines are not used by children in care.

9.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Counter tops, shelves, areas in front of window, and smallspaces are kept clutter-free and big spaces are set up sothat children have clear play spaces that staff canobserve.

Sleeping Equipment and Sleeping, Resting Supervision

10.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All bedding and sleeping equipment is appropriate for thechild and clean, comfortable, safe, and in good repair.

10.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All sleeping equipment and bedding is washed, rinsed,and sanitized when soiled, between uses by differentchildren, and at least once a week regardless of use bydifferent children.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Sleeping Equipment and Sleeping, Resting Supervision

10.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

When sleeping equipment and bedding is stored:

*Sleeping surfaces do not come in contact with othersleeping surfaces.*Bedding does not come in contact with other bedding.

10.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Children under 3 years of age are provided opportunitiesto rest regardless of the number of hours in care.

10.5 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Naptime or quiet time is provided when children underschool-age are in attendance 5 or more continuous hoursper day.

10.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Resting or sleeping areas have adequate soft lighting (notdark) to allow the caregiver to assess children.

10.7 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Children, including sleeping children, are never leftunsupervised. A staff person must be physically presentat all times.

10.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

It is permissible to place cots and mats in such a mannerthat one or two sides are adjacent to a wall. The remainingtwo or three sides must be at least 18 inches from anotheroccupied cot or mat.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Ratio and group size requirements

11.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

In each room or well-defined space, the maximum groupsize and ratio of caregivers to children, including childrenrelated to a staff member or the licensee, are thefollowing:*30 months until 3 years – 1:8, group size 16.*3 years until 4 years – 1:10, no maximum group size.*4 years until school age – 1:12, no maximum group size.*A 1:8 adult/child ratio must be maintained at all times. Aconsistant third adult must be present in any classroomwhere 17 or 18 children are enrolled. Class size must becapped at 18 children with three consistent adults. (GSRPonly)

11.2 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

If there are children of mixed ages in the same room orwell-defined space, then the ratio and group size shall bedetermined by the age of the youngest child.

Water supply; plumbing; toilets; handwashing sinks; bleach water

12.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All plumbing fixtures and water and waste pipes aremaintained in good working condition.

12.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Handwashing sinks are accessible to children by platformor installed at children’s level.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Water supply; plumbing; toilets; handwashing sinks; bleach water

12.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Handwashing sinks have running water that does notexceed 120 degrees Fahrenheit.

12.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Supplies, including toilet paper, hand soap, and towels,are available and accessible.

12.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Test strips are used to check the concentration of thebleach/water solution each day.

12.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Follow the 3-sink dishwashing method or use acommerical dishwasher with a sanitizing cycle.

12.7 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Cleaning supplies and other potentially dangerousmaterials and toxins are stored in a locked cabinet whennot in use.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Garbage and refuse

13.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All garbage is removed from the center daily.

13.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Garbage containers are washed when soiled.

13.3 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Garbage stored outside is in sealed plastic bags inwatertight containers with tight-fitting covers or in acovered dumpster.

13.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Outside garbage and refuse is picked up or removed at aminimum of once a week.

Heating; temperature

14.1 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

A themometer is used in child-use areas to monitor thatthe indoor temperature is at least 65 degrees Fahrenheitin child use areas at a point 2 feet above the floor.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Heating; temperature

14.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

If temperatures exceeds 82 degrees Fahrenheit,measures are taken to cool the children.

Premises

15.1 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Windows and doors used for ventilation are supplied withscreens that are in good repair. This does not apply toprograms operating in school buildings.

15.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Propping doors open for ventilation is prohibited.

15.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Stairs, walkways, ramps, landings, and porches:

*Are maintained in a safe condition relative to the water,ice, or snow, and have nonslip surfacing.*Landings are located outside exit doors where steps orstairs are necessary and are at least as wide as the doorswing.

15.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The premises do not pose a threat to health or safety andare maintained in a clean and safe condition free frommold, pollutants (including smoke, lead, pesticides, orherbicides, as well as soil and water pollutants), hazards,and toxins.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Premises

15.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The premises are maintained so as to eliminate andprevent rodent and insect harborage.

15.6 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Roofs, exterior walls, doors, skylights, and windows areweathertight, watertight, in sound condition, and in goodrepair.

15.7 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Floors, interior walls, and ceilings are in sound conditionand in good repair. They are also maintained in a cleancondition.

15.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All toilet room floor surfaces are easily cleanable,impervious to water, and in a clean condition.

15.9 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Light fixtures, vent covers, wall-mounted fans, and similarequipment attached to walls and ceilings are easilycleanable and in good repair.

15.10 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Containers of poisonous or toxic materials are labeled foreasy identification of contents, stored out of the reach ofchildren, and in a locked cabinet. Toxic materials will notbe used when children are present.

© ChildPlus

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8020 - Monitoring Worksheet

Premises

15.12 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Lighting is bright enough so children and adults canclearly see activities, materials, and pathways. Theclassroom is free of lamps (desk, table, wall, etc.)

15.11 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Flammable materials, including fuels, pressurized cans,cleaning fluids and supplies, polishes, and matches, arenot stored in heat plant enclosures. They may be storedoutside of child use areas in metal cabinets or storagefacilities accessible only to authorized personnel.

15.13 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Necessary accommodations and modifications are madeto ensure the safety, comfort, and full participation of allchildren, including those with special needs.

15.14 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Exit doors have no more than one locking or latchingdevice. Deadbolts are not permitted.

15.15 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Emergency lighting is available to allow children andadults to clearly see pathways in case of a power failure(flashlights).

15.16 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Staff will refer to and follow NMCAA cleaning, sanitizing,and disinfecting guidance and routine center cleaningtimeline. A mouthed toy bin is labeled and available.

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Premises

15.17 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The premises are free from firearms or other weapons thatare accessable to children.

15.18 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Following NMCAA's animal and pet policy, children areprotected from any hazards posed by classroom or familychild care pets.

15.19 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Premises are kept free of undesirable and hazardousmaterials and conditions. Indoor and outdoor premises areinspected prior to each use by children. Findings aredocumented on the Daily Classroom/Outdoor Cleaning &Inspection Log.

Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Personal belongings/purses should be stored and lockedout of the reach of children. (Any hand lotions, essentialoils, cough drops, hand sanitizer, and personal medicationmust also be locked and kept out of the reach of children.Ensure jacket pockets do not contain any items thatshould be kept out of the reach of children).

Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All appliances such as refrigerators are plugged directlyinto a wall outlet. Do not use an extension cord.

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Premises

Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All plants must be labeled and non poisonous per the listin the procedure manual.

Fire Safety

16.1 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Draperies, curtains, decorations, and other similarfurnishings are flame-resistant with application datesnoted on the Drill & Safety Check Log.

16.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Bulletin boards meet interior finish requirements and havepassed the fire inspection.

16.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Combustible materials and decorations displayed on wallsdo not exceed 20% of each wall in each room.Combustible materials and decorations suspended from ornear the ceiling are prohibited.

16.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Doorways, hallways, entrance ways, and any other areasused for entering or exiting the building must bemaintained so they are free of obstructions that may catchfire or hinder evacuation. These areas must not be usedfor storage.

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Fire Safety

16.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Exterior exits are marked or denoted by an approved exitsign.

16.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Combustible materials are not stored within the centralheating plant, fuel-fired water heater rooms, or inbasements containing fuel-fired heating equipment,without proper fire separation.

16.7 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Gasoline-powered equipment, flammable gases, orgasoline are not stored in the part of a building used as acenter or in other parts of the building from which there isa door, window, or other opening into the center.

16.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Dryer vents are metal and are vented completely to theexterior.

16.9 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

All appliances and equipment in the center are installedand maintained in accordance with their manufacturer’sspecifications.

16.10 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Centers are kept free of all conditions that constitute firesafety hazards.

© ChildPlus

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Fire Safety

16.11 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Open-flame devices, candles, and incense are prohibited.

Smoke and carbon monoxide detectors; fire extinguishers

17.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A carbon monoxide detector is placed on all levelsapproved for child care and in each use area covered by adifferent furnace zone. Carbon monoxide detectors areinstalled, maintained, and tested in accordance to themanufacturer recommendations. Staff check expirationdate on the detector.

17.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Smoke detectors are installed, maintained, and tested inaccordance to the manufacturer recommendations(instructions are posted safely near detector). Staff checkexpiration date on the detector.

17.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Multipurpose fire extinguishers are installed adjacent tothe kitchen or cooking area and in the heating plant room.

17.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Fire extinguishers are properly mounted, maintained, andinspected and have a tag dated and initialed by theinspector yearly. Fire extinguishers are readily accessibleto staff.

© ChildPlus

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Smoke and carbon monoxide detectors; fire extinguishers

17.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Staff must inspect extinguishers and initial monthly on theattached tag.

Electrical Services

18.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Extension cords are only used temporarily for a specificoccasion such as using a projector or cd player. Theymust be removed when not in use. Temporary extensioncords should not be placed through doorways, undercarpeting, or across water-source areas.

18.2 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Electrical outlets accessible to children must be coveredwith child safety hardware.

18.3 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Power strips are equipped with surge protectors and arenot longer than 6 feet or connected to another power strip.

18.4 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

All electrical outlets in approved child use space locatedwithin 6 feet of a sink or other water source shall beprotected by a ground-fault circuit interrupter (GFCI).

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

A staff member must be present at the center whilechildren are riding the bus to and from school. This isgenerally an hour before school starts and an hour afterschool starts.

19.2 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Active Supervision is used to ensure safety on the bus.The driver and all adult passengers are seated accordingto the seating capacity.

19.3 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Staff maintain up-to-date child rosters and lists of theadults to whom each child is authorized to be released,including alternates in case of emergency.

19.4 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

When children are entering or leaving the vehicle:

*Children are received by a staff person, parent, or otherperson as designated by the parent*Children enter and leave the vehicle from the curbsideunless it is in a protected area or driveway*An adult escorts children across the street to board orleave the vehicle if curbside pickup or drop-off isimpossible

19.5 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Children under school-age are helped into and out of thevehicle.

© ChildPlus

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2019-20 Head Start Safe Environments Checklist

8020 - Monitoring Worksheet

Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.6 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Transportation routes are planned so no child underschool-age is in the vehicle longer than 1 continuous hour.Trip routing prevents vehicles from exceeding maximumpassenger capacity.

19.7 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Special transportation requirements stated in a child's IEPare followed, including special drop-off and pickuprequirements, seating requirements, equipment needs,any assistance that may be required, and any necessarytraining for the bus driver and monitors.

19.8 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Children are only released to a legal guardian or writtendesignee as noted on the child information record. Staffmust check and photocopy identification (take a picture ofthe identification, if needed) when releasing a child to anyperson they do not know, even if the child recognizes theindividual. Staff must check to ensure this person's nameis on the child information record and attach a copy of theidentification to the record

19.9 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Emergency medication (EpiPen, Inhaler) are stored out ofchildren's reach on the bus and are quickly accessible atall times (should not be in a locked box). All othermedication should be transported in a locked box on thebus. Children are not to carry medications to school intheir backpack. Medication must be given from adult tostaff.

© ChildPlus

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.10 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Child information records are on the bus, maintained andupdated as needed with parent signatures, phonenumbers, addresses (emergency information).Emergency care plans are stapled to the child informationrecords and must be reviewed throughout the year forchanges. Any changes to the child information recordmust be communicated to the bus driver.

19.11 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Staff complete a daily/weekly transportation log. (Ifapplicable, note route # and any variations from regularroute).

19.12 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All motor vehicles are in safe operating condition.

19.13 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Documentation of annual MSP inspection sticker isdisplayed on the windshield and a copy is kept on file.

19.14 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

A statement verifying that all motor vehicles are incompliance with Michigan Vehicle CodeSafety Equipment requirements is kept on file.

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.15 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Baggage and other items transported in the passengercompartment are properly stored and secured; the aislesremain clear and the doors and emergency exits remainunobstructed at all times.

19.16 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

All motor vehicles carry the following safety equipment:

*Three bi-directional emergency reflective trianglesproperly cased and securely stored in the vehicle*A labeled first aid kit is securely stored in an accessiblelocation in the driver compartment*Seat belt cutter*Equipped with a reverse beeper*Not less than 3 15-minute fuses (flares) or an approvedbattery operated substitute properly cased and securelystored in the driver’s compartment*A labeled and charged dry chemical fire extinguisher, notless than 2A-10BC, mounted in the driver compartment.The fire extinguisher is inspected, maintained, and tagged.

19.17 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Each child remains seated and properly restrained by achild safety restraint system while the vehicle is in motion.(Child safety restraint systems are not required on publicschool buses and transit buses).

19.18 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Each child safety restraint system is properly anchoredand used according to the manufacturer’s specifications.Two or more children are not allowed to share a seat beltor restraint device.

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.19 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Safety belts and child safety restraint systems are in goodworking condition and are appropriate to the child's age,height, and weight.

19.20 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Transportation staff:

*Is familiar with the contents of the first aid kit*Is familiar with the operation of the fire extinguisher, ifrequired*Is familiar with the seat belt cutter

19.21 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The following documents are on file at the center:

*A copy of each driver’s driving record, obtained from theSecretary of State at least once a year.*A copy of a valid driver’s license, automobile insurance,and registration.

19.22 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The driver must complete a walk-through on the bus at theend of each run and place the "I have completed a walk-through on this bus" sign on the door at the back of thebus. Children are not left unattended in a vehicle. Busmonitors and drivers complete pre- and post-trip vehiclechecks, including second or third complete interiorinspections to ensure no child is ever left on a vehicle.

19.23 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Bus driver cell phone is in working condition and secured.Emergency numbers are programmed on the phone.

© ChildPlus

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.24 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The bus driver daily inspection form is completed daily.

19.25 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Drivers do not back up or make U-turns, except whennecessary for safety reasons or because of physicalbarriers.

19.26 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Stops are located to minimize traffic disruptions and toafford the driver a good field of view in front of and behindthe vehicle.

19.29 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

The following forms must be posted on the bus:

*Transportation safety procedures*Bus procedures in emergency situations*Emergency phone numbers, including 911, fire, police,and poison control*No smoking sign*"I have completed a walk-through on the bus" sign*Fire extinguisher sign*Seatbelt cutter sign

19.27 Non-CompliantNot ApplicableNot ObservedCompliant Notes:

Whenever possible, children with disabilities must betransported in the same vehicles used to transport otherchildren enrolled.

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Transportation

All classrooms should complete this section. Some items may not applicable to every site.

19.28 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Bus drivers must have the following on the bus:

*Proof of valid driver’s license with appropriateendorsements and CDL physical*Proof of valid automobile insurance and registration

Licensing Notebook-located in the parent corner of the classroom

20.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

Licensing Notebook must contain the following items:

*Licensing Notebook Checklist*Licensing Notebook Summary Sheet BCAL 5052(updated)*Original Inspection Report*Addendum to the Original Inspection Report*Renewal Inspection Report(s)*Interim Inspection Report(s)*Special Investigation Report(s)*Corrective action plans*Facility Lead Inspection (if applicable)*Playground Inspection Report (if applicable)*Environmental Health Inspection*Head Start Parent Orientation Training Review Checklistor GSRP Child Development Parent Orientation TrainingReview Checklist*Classroom Floor Plan with Dimensions*Playground Equipment Lay Out with Dimensions*Drill and Safety Check Log (for entire licensing cycle)

© ChildPlus

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Postings-Emergency Procedures

Ensure all postings are placed at eye-level.

22.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

*Allergy and Health Monitoring form (placed in redconfidential allergy information folder wherever food isprepared and served).*Bus Procedure in Emergency Situations (to be postedeven if site does not offer transportation)*Crisis Management Plan/Lockdown Procedure(accessible to staff only)*Drill and Safety Check Log*Emergency Procedures Posting (posted in a place visibleto both staff AND parents; ensure posting includesrelocation sites)*Emergency Telephone Numbers (posted near all centertelephones)*Fire and evacuation routes*Pediatric First Aid/CPR/AED Ready Reference Guide*Transportation Safety Procedures (to be posted even ifsite does not offer transportation)

21.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

*"And Justice For All" poster*Copy of Licensing Rules for Child Care Centers (January2, 2014 edition)*Current lesson plan*Help wanted sign/Join our team*NMCAA Head Start/GSRP Complaint Policy andProcedure/Civil Rights Complaint Procedure*NMCAA Head Start/GSRP Guidance Policy*Parent handbook*Parent resources*Planned menus*Welcome Sign*What do you think of your program? (with folder)

© ChildPlus

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Postings-the following items are current and posted in the classroom

Ensure all postings are placed at eye-level.

23.1 Non-CompliantNot ApplicableNot ObservedCompliant

Notes:

*Active Supervision poster*Current State of Michigan License for the Care ofChildren*Current Consumer Product Safety Commission ProductRecalls for Children's Safety*Daily schedule including times*Diaper changing procedure and maintenance of changingtables/surfaces (near diaper changing area)*Exit signs*Handwashing guidelines (posted at all sinks used forhandwashing by staff and/or children)*No smoking sign*Routine center cleaning*Screening policy*Team Vision Statement (optional)*Volunteer Supervision Policy

© ChildPlus