CFS 602 Form PDF Details

In the realm of ensuring the health and safety of children in care environments, the CFS 602 form plays a pivotal role within the state of Illinois. Administered by the Department of Children and Family Services, this comprehensive medical report is requisite for adults involved in various capacities at child care facilities, including employees, volunteers, operators of day care/group day care homes, and other adult members of these individuals’ households. Its primary function is to meticulously assess the medical and emotional fitness of adults to work or volunteer in settings that cater to children, spanning from infancy through adolescence. The form encompasses sections for detailed health screenings, including mandatory tuberculin tests or chest X-rays for first-time examinations, alongside evaluations of any medical or emotional conditions that might impede the individual’s ability to care for children. Furthermore, it probes into specific roles like food handling and driving responsibilities within child care facilities, underlining the state's commitment to a holistic approach in safeguarding child welfare. Recommendations and findings from a medical professional determine the suitability of adults in child care roles, aiming to foster environments that are not only safe but conducive to the healthy development of children. Ensuring compliance with the medical requirements illustrated in the CFS 602 form thus becomes a critical step for child care facilities operating under the jurisdiction of Illinois’ Department of Children and Family Services.

QuestionAnswer
Form NameCFS 602 Form
Form Length2 pages
Fillable?Yes
Fillable fields81
Avg. time to fill out16 min 46 sec
Other namesform cfs 604, cfs 602 illinois, dcfs cfs 602, medical report on an adult in a child care facility

Form Preview Example

CFS 602

Rev. 9/2002

STATE OF ILLINOIS

Department of Children and Family Services

MEDICAL REPORT ON AN ADULT IN A CHILD CARE FACILITY

(Includes employees and volunteers in DCFS licensed child care facilities, operators of day care/group day care homes and other adult members of their households)

(Name of Person Examined)

(Birth Date)

Position (check one)

Day Care/Group Day Care Home Caregiver

Child Care Staff

Other Staff in a Child Care Facility Member of Household

Name of Licensee/applicant for License or Licensed Facility where individual is employed/volunteers

Address

Food Handler (See Section B)

Child Care Facility Driver (See Section B) Volunteer in a Child Care Facility

 

Street

City

 

Zip Code

County

I. TESTS

Date

 

 

Results

Tuberculin test (by the Mantoux method or chest X-ray

 

 

 

 

in a positive reactor)*

 

 

 

 

Other (specify):

 

 

 

 

 

 

II.FINDINGS AND RECOMMENDATIONS

A.Findings

Summary of medical or emotional problems or conditions, if any, which may affect the individual’s ability to work, volunteer or reside in a facility caring for children.

B.Any conditions which contraindicate a person serving as a Food Handler or Child Care Facility Driver?

Yes No

If yes, please specify

C.Recommendations

The above individual was found free from symptoms of communicable disease and is otherwise medically and emotionally

fit to work, volunteer or reside in a facility caring for children. Yes No Explain “No”:

In my opinion, the individual could meet the strength and mobility challenges required for caring for a child in one or more of the age groups checked below:

0-2 years of age

2-6 years of age

7-12 years of age

12-18 years of age

Date of Examination

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

Physician’s Signature

 

 

 

 

 

 

 

 

 

Street Address

City

State

Zip Code

 

 

 

 

 

 

Telephone Number

 

 

 

* Required in initial examination only. Physician to determine need for test in subsequent examinations.

REEXAMINATIONS

Date of Examination

 

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Examination

 

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Examination

 

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Examination

 

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Examination

 

Physician’s Name (Print) and State License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Examination

Physician’s Name (Print) and State License Number

How to Edit CFS 602 Form Online for Free

You could complete dcfs physical form for adults instantly with the help of our PDFinity® PDF editor. To retain our editor on the forefront of convenience, we work to put into practice user-oriented capabilities and improvements on a regular basis. We're always looking for feedback - join us in revolutionizing the way you work with PDF documents. For anyone who is seeking to get going, here is what it will take:

Step 1: Access the PDF doc inside our editor by hitting the "Get Form Button" in the top section of this webpage.

Step 2: The editor will allow you to modify your PDF in a range of ways. Modify it by including personalized text, adjust existing content, and include a signature - all close at hand!

Pay attention while filling in this form. Ensure that all necessary blanks are done correctly.

1. The dcfs physical form for adults usually requires certain information to be typed in. Ensure that the subsequent blank fields are completed:

Simple tips to prepare medical report on an adult in a child care facility portion 1

2. Once the previous segment is complete, it's time to insert the necessary particulars in Summary of medical or emotional, B Any conditions which, Yes, If yes please specify, C Recommendations, The above individual was found, Yes, years of age, years of age, years of age, years of age, Date of Examination, Physicians Name Print and State, Physicians Signature, and Street Address so you're able to proceed further.

medical report on an adult in a child care facility conclusion process clarified (part 2)

3. This stage is simple - complete every one of the form fields in Date of Examination, Physicians Name Print and State, Date of Examination, Physicians Name Print and State, Date of Examination, and Physicians Name Print and State to complete this segment.

Completing section 3 of medical report on an adult in a child care facility

4. The next subsection arrives with the next few fields to consider: Date of Examination, Physicians Name Print and State, Date of Examination, and Physicians Name Print and State.

medical report on an adult in a child care facility conclusion process detailed (step 4)

It's very easy to make a mistake when completing your Date of Examination, consequently be sure to take a second look prior to when you submit it.

5. To finish your document, the last area features a couple of additional blank fields. Entering Date of Examination, and Physicians Name Print and State should conclude everything and you can be done in an instant!

Filling in segment 5 in medical report on an adult in a child care facility

Step 3: Just after rereading your completed blanks, press "Done" and you're all set! Try a free trial option at FormsPal and acquire immediate access to dcfs physical form for adults - which you may then work with as you would like inside your FormsPal account page. FormsPal offers secure document editor with no personal data record-keeping or sharing. Be assured that your information is in good hands here!

CFS 602 Form isn’t the one you’re looking for?

Related Documents