ࡱ>  @ 8$bjbj W+4x*x*x*h*tT+LUr,....02L3R$UUUUUU$VRCY$U4/"044$U..%9U:::48..R:4R:: K|L., Ox*5K(MOU0UKY6Y$L4FJYL44:44444$U$Ut%w:t%CHILD CARE HOME RECORD REQUIREMENTSMichigan Department of Human ServicesBureau of Children and Adult Licensing REQUIRED REGISTRANT/LICENSEE RECORDS FORMCHECKBOX Dates of registrant/licensee absences R 400.1903(1)(e) FORMCHECKBOX Name, address, phone number of caregivers present during registrant/licensee absences R 400.1903(1)(e) FORMCHECKBOX Written and signed agreement from the person (who must be responsible and age 18 years and older) who will provide care and supervision for children during an emergency R 400.1903(1)(f) FORMCHECKBOX Current first aid training (updated every 3 years) R 400.1902(1)(d), 400.1905(8) FORMCHECKBOX Current adult, infant, and child CPR training (updated annually) R 400.1902(1)(d), R 400.1905(8) FORMCHECKBOX Blood-borne pathogen training R 400.1902(1)(d), R 400.1905(4) FORMCHECKBOX Training record/documentation of 10 hours completed annually R 400.1905(1) FORMCHECKBOX Medical statement (dated within 1 year before issuance and at subsequent renewals) R 400.1906(1)(b)(i) FORMCHECKBOX TB test results (only required one time before issuance of registration/license) R 400.1906(1)(c)(i) FORMCHECKBOX Mental health statement, if applicable R 400.1903(1)(i)REQUIRED HOUSEHOLD MEMBER RECORDS FORMCHECKBOX TB test results for anyone 14 or older (only required once either before issuance of registration/license or anytime a household member turns 14) R 400.1906(2) FORMCHECKBOX Mental health statement, if applicable R 400.1903(1)(i)  REQUIRED ASSISTANT CAREGIVER RECORDS FORMCHECKBOX Documentation of full name, address and telephone number R 400.1906(1)(a) FORMCHECKBOX Current first aid training within 90 days of hire and updated every 3 years R 400.1904(1)(c), 400.1905(8) FORMCHECKBOX Current adult, infant, child CPR training within 90 days of hire and updated annually R 400.1904(1)(c), 400.1905(4) FORMCHECKBOX Blood-borne pathogen training R 400.1904(1)(c), 400.1905(8) FORMCHECKBOX Training record/documentation of 5 hours completed annually R 400.1905(2) FORMCHECKBOX Documentation of shaken baby syndrome and infant safe sleep training R 400.1905(3) FORMCHECKBOX Medical statement (dated within 1 year before caring for children and at subsequent renewals) R 400.1906(1)(b)(ii) FORMCHECKBOX TB test (required once prior to caring for children) R 400.1906(1)(c)(ii) FORMCHECKBOX Documentation from DHS that assistant caregivers age 18 and older has not been involved in substantiated child abuse/neglect (obtained by BCAL for assistant caregivers who are household members) R 400.1906(1)(f) FORMCHECKBOX Self-certifying statement from assistant caregivers under age 18 that they have not been involved in substantiated child abuse/neglect R 400.1906(1)(f)   FORMCHECKBOX Signed/dated statement from each assistant caregiver that states that the individual:Has not been convicted of child abuse or child neglect. Has not been convicted of a felony involving harm or threatened harm to an individual within 10 years preceding the date of hire. Is aware child abuse and neglect is unlawful. Knows that he/she is a mandated reporter of suspected child abuse/neglect. Has received a copy of the homes discipline policy. R 400.1906(1)(e)(g) FORMCHECKBOX Mental health statement, if necessary R 400.1903(1)(i)(All assistant caregiver records must be retained for four years after employment ceases.REQUIRED CHILD RECORDS FORMCHECKBOX Child Information Record (BCAL-3731 or comparable substitute), fully completed and updated annually and when information changes R 400.1907(1)(a), 400.1907(2) FORMCHECKBOX Child in Care Statement/Receipt (BCAL-3900), fully completed and updated annually and when information changes R 400.1907(1)(b), 400.1907(2) FORMCHECKBOX Dated daily attendance records, includes childs first and last name R 400.1907(3) FORMCHECKBOX Medication Permission (BCAL-1243 or comparable substitute) form for each medication, if applicable R 400.1918(2) FORMCHECKBOX Documentation of medication dispensed using Medication Permission (BCAL-1243 or comparable substitute) form, if applicable R 400.1918(7) FORMCHECKBOX Parental permission for water activities, if applicableBefore each outdoor water activity at a swimming pool, lake, or other body of water off the child care premises. Seasonally for water activities on the child care premises. R 400.1921(10)   FORMCHECKBOX Parental permission for transportation, if applicableFor routine transportation, obtain permission annually. For all other transportation, obtain permission before each time (daily) the child is transported. R 400.1952(2)(3) FORMCHECKBOX For field trips off the child care premises, not involving transportation, obtain parental permission at the time of initial enrollment R 400.1952(4)(Childrens records must be accessible to all caregivers R 400.1907(4)(Childrens records must be retained for a minimum of 4 years R 400.1907(5)REQUIRED HOME RECORDS FORMCHECKBOX Written discipline policy R 400.1913(1) FORMCHECKBOX Written plan for the following emergencies:Fire evacuation. Tornado watches and warnings. Serious accident or injury. Water emergencies, if applicable. R 400.1945(1) FORMCHECKBOX Written records of monthly fire drills, including date and time it takes R 400.1945(3) FORMCHECKBOX Written record, including date and time of monthly tornado drills from April to October each year R 400.1945(4) FORMCHECKBOX Radon test results R 400.1934(4) FORMCHECKBOX Written reports provided to the department of a serious injury, accident, illness, or medical condition of a child which results in emergency medical treatment, hospitalization or death R 400.1962 FORMCHECKBOX Written reports provided to the department regarding a fire in the child care home that result in loss of property or personal injury R 400.1962  REQUIRED POSTINGS FORMCHECKBOX Current license or certificate of registration R 400.1903(g) FORMCHECKBOX Notice that smoking is not permitted on the premises during child care hours R 400.1903(8)(b) FORMCHECKBOX Written plan for the following emergencies:Fire evacuation. Tornado watches and warnings. Serious accident or injury. Water emergencies, if applicable. R 400.1945(1) FORMCHECKBOX An updated copy of the list of unsafe childrens products that is provided by the department (in MCCM) R 400.1915(4) FORMCHECKBOX Window exits clearly identified R 400.1943(3)(b)  BCAL-5040 (Rev. 6-09) MS Word  PAGE 3 Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. 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