Action Plan | This is a universal tool for the provider and consultant which is applicable to continuous quality improvement actions: i.e. Department of Health and Human Services (HHS) Referrals,Iowa Quality for Kids (IQ4K®) Strategies, ChildNet Certifications or training key concepts. English» Spanish » |
CDH Forms Book | Required & suggested forms booklet from CCR&R. Go to Form |
CDH Guide to Developing Business Policies | Policy guidebook offers suggestions of items to think about when creating policies for a family child care business. English Guidebook » Spanish Guidebook » Guidance Form » |
Child Enrollment Information | Required information from HHS checklist, 110.9(4)A and B. Packet of required information to be kept in the children’s file for each child enrolled. English fillable EP Spanish |
Children's File Review Chart Checklist | Checklist of required information to be included in each child's file. Go to Form |
Consent & Release | Required information for HHS checklist, 110.9(4)I and J Parent consent and release form addressing child pick up, trips, transportation, swimming, photos and other. English Spanish fillable |
Egress Windows | Required information for HHS checklist, 110.14(3)C. Child Development Homes (CDH) can use this document to learn about emergency exits. Go to Form |
Emergency Contact List for Posting | Child Development Homes (CDH) can use this document to post emergency numbers. Go to Form |
Emergency Medical Treatment Authorization | Required information for HHS checklist, 110.9(4)B and C. Packet of required information to be kept in the children's file for each child enrolled. English fillable Spanish |
Emergency Phone Number List | Required information for HHS checklist, 110.8(1)A. Information should be readily accessible. English Spanish |
Emergency Practice Drill Evaluation Tool | Required information for HHS checklist, 110.8(4)A. Information should be readily accessible. English Spanish |
Emergency Practice Drills Record | Required information for HHS Checklist, 110.8(4)A. Fire and tornado drills are practiced monthly and documentation kept on file for the current year and previous year. English Spanish |
Emergency Preparedness Additional Resources | This link will take you to the Emergency Preparedness page. Iowa law requires child care providers to have a written emergency plan in place by October 1, 2016. There are templates and tools available for child care providers to help meet your program's needs. You are not required to use any of the templates and tools offered, although the tools and templates will help you meet requirements in Iowa law. Go to EP Webpage |
Equipment Checks Form | Required information for HHS Checklist, 110.8(1)G and H. Information should be readily accessible for equipment checks of smoke detectors, carbon monoxide detectors, fire extinguisher and evacuation equipment. English Spanish |
Fire & Tornado Symbol | This link will take you to the Emergency Preparedness page. Fire and tornado symbols may be used as visual aids to help children understand the required written emergency plans posted by the primary and secondary exits. View |
Health FormInfant, Toddler, Preschool Age | Required information for HHS checklist, 110.9(4)D. The provider should give this form to the parent/guardian of the attending child, to have the form completed by a physician. The provider should then keep a copy of this form in the child's personal file. English Fillable Spanish |
Health FormSchool-age Child, Parent Statement of Health | Required information for HHS checklist, 110.9(4)D. The provider should give to the parent/guardian of the attending child for completion. The provider should then keep a copy of this form in the child's personal file. English Fillable Spanish |
Healthy Child Care Iowa (HCCI) | Examples of forms and other available information on this site include: Breastfeeding support, child illness guide, diapering procedures, electrical outlet safety, exposure plan, first aid checklist, handwashing instructions, infant daily report, injury report, mandatory reporting site poster, sleep safe policy, etc. |
Immunization Certificate - Provisional | When a Certificate of Immunization or Immunization Exempt Form are not available, a Provisional Certificate of Immunization can be used. Expiration date is usually 60 days. If the immunizations are further behind than can be caught up in 60 days, another provisional can be issued for an additional 60 days. As you can see on the record, a child must have received at least one dose of each of the required immunizations for this to be a valid option. Go to Form |
Immunization Exempt FormMedical or Religious | Form parents complete if they refuse to immunize their children because of religion or doctor recommendation. Medical Form Religious Form |
Mandatory Reporting Site Poster | Suggested poster by Child Care Nurse Consultants for Health & Safety Assessment. Designated poster from HHS to postfor notifying parents that they operate a mandatory child abuse reporting site. |
Medication Record | Required information for HHS checklist, 110.8(3)C. Form to be completed by the parent and provider when an enrolled child is given any medicine, topical cream, sunscreen, diaper ointment, breathing treatment, etc. Parent signature is required. English Spanish |
Monthly Fire Drills, Smoke Alarms, Tornado Drills | This link will take you to the Emergency Preparedness page. Form to document when provider has practiced monthly fire/tornado drills and changed batteries in smoke alarms. View |
Professional Development Record for CDH | Form to document training requirements prior to registration and tracking of required professional development hours for each registration period. English PDF English Word Spanish |
Renovation, Remodeling & Repainting Rule FAQ | Renovation can disturb paint and this includes sanding, cutting, and demolition. Learn how this can hurt adults and children. View |
Renovation, Remodeling & RepaintingLead Hazard Notification Process | This applies to all persons who perform renovation, remodeling, or repainting for compensation in target housing or a child-occupied facility. Go to Form |
Safe Sleep ABC's | Required information for HHS checklist, 110.8(5)A through D. Safe Sleep procedures for providers and parents. English » Spanish » Burmese » Swahili » |
Self-Assessment Inspection for CDH | This self-assessment will be used by the provider and Child Care Consultant to assure homes are a safe, nurturing place for children that promote developmentally appropriate practices. Use this form to prepare for your DHS annual inspection. Visuals Form |
Smoke-Free Air Signs | Required information for HHS checklist, 110.8(1)I. A direct link to the Iowa Department of Health Smoke-Free Air Act information including a link to print signs. Website 4x6 Sign |
Transporting Children | Required information for HHS checklist, 110.8(1)M. This link will take you to the Iowa Child Restraint Law document. |
Weather Watch for Child Care | Chart will help plan for safe daily outdoor time. Go to Form |
