Download New York Daycare Annual Staff Template in PDF Open New York Daycare Annual Staff Editor Now

Download New York Daycare Annual Staff Template in PDF

The New York Daycare Annual Staff form is a crucial document required by the New York City Department of Health and Mental Hygiene. This form ensures that all teaching and non-teaching staff, including volunteers and students, undergo a health examination at the start of their employment and every two years thereafter. It plays a vital role in maintaining the health and safety of children in daycare settings.

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Similar forms

  • Employee Health Assessment Form: Similar to the New York Daycare Annual Staff form, this document is used by various employers to assess the health status of their employees. It requires details about medical history, current health conditions, and any necessary vaccinations. Both forms aim to ensure that staff members are fit for their roles, particularly in environments where health and safety are paramount.
  • School Health Screening Form: This form is often utilized in educational settings to gather health information about students and staff. Like the daycare form, it includes sections for medical history, immunization records, and assessments of physical fitness. The goal is to promote a healthy school environment and prevent the spread of illness.
  • Childcare Staff Health Record: This document serves a similar purpose to the New York Daycare Annual Staff form by documenting the health status of childcare providers. It includes health examinations, immunization history, and any chronic health issues. Both forms are essential for ensuring that caregivers can safely interact with children.
  • Volunteer Health Declaration: Many organizations require volunteers, especially those working with children, to complete a health declaration form. This document gathers information on medical history and health conditions, similar to the daycare staff form. It ensures that volunteers are healthy enough to participate in activities that involve child care.
  • Fitness for Duty Certificate: This certificate is often required for employees in physically demanding jobs. It assesses whether an individual is physically capable of performing their job duties. Like the daycare staff form, it requires a medical examination and documentation of health status to ensure safety in the workplace.
  • Immunization Record Form: This form is used to track vaccinations for both children and staff in various settings. It is similar to the immunization section of the daycare staff form, which requires evidence of immunity to specific diseases. Both forms are crucial for maintaining public health standards and preventing outbreaks in group settings.

Guide to Filling Out New York Daycare Annual Staff

Completing the New York Daycare Annual Staff form is a crucial step for ensuring that all staff members meet health requirements for working with children. This process involves gathering necessary personal information, medical history, and documentation of immunizations. Following the steps outlined below will help in accurately filling out the form.

  1. Begin by locating the form and ensuring you have all necessary documents ready, such as medical records and immunization history.
  2. Fill in the Date of Employment and Date of Exam at the top of the form.
  3. Enter the staff member's Last Name, First Name, and Middle Name.
  4. Indicate the staff member's Sex by checking either the box for F (Female) or M (Male).
  5. Provide the Date of Birth in the specified format.
  6. Complete the Address section, including Street, City/Boro, State, and Zip Code.
  7. Fill in the Telephone number and Job Title.
  8. In the Past Medical History section, check either YES or NO for each listed condition. If any conditions are marked as YES, provide explanations and details about chronic medications or therapies.
  9. In the Medical Provider Section, record the results of the physical exam, including Height, Weight, and Blood Pressure.
  10. Indicate Tobacco Use status by checking the appropriate option and whether cessation services were recommended.
  11. If applicable, fill out the Tuberculin Testing section, including the date tested and results.
  12. Complete the Immunization Record by documenting vaccines received, including Tdap, Rubella, Measles, Mumps, and Varicella. Ensure to check if each vaccine was documented or if there is a provider-documented history of illness.
  13. If laboratory tests were ordered, specify them in the Laboratory Tests section, along with dates and results.
  14. At the bottom of the form, the Provider’s Name, License Number, and Telephone Number must be filled in. The provider must also sign the form.
  15. Finally, ensure that the Staff Signature is completed and dated.

After completing the form, it is important to keep it confidential and file it separately from other records at the daycare center. This will ensure compliance with health regulations and protect the privacy of staff members.