Ensuring the safety and well-being of children in day care settings is a paramount concern that involves coordination between child care providers and local emergency services. The OCFS-4939 form, issued by the New York State Office of Children and Family Services, plays a crucial role in this process. It mandates child day care providers to officially notify their local fire and police or sheriff departments about the location of their day care program. This step, required within five days after receiving their license or registration, is designed to streamline emergency responses if needed. The form not only facilitates effective communication between child care programs and emergency responders but also helps in the planning and execution of potential rescue operations, ensuring that first responders are aware of the specific needs and circumstances of the day care's occupants. By detailing the operational hours, the age range of children served, and maintaining updated records of notification, the OCFS-4939 form serves as a critical tool in enhancing child safety. Providers are also encouraged to keep a copy of this notification for their records, underscoring the importance of documentation in child care safety protocols, and may also inform 911 services in communities where it is available, further emphasizing the commitment to child safety in every aspect of day care operation.
| Question | Answer |
|---|---|
| Form Name | Form OCFS-4939 |
| Form Length | 1 pages |
| Fillable? | Yes |
| Fillable fields | 64 |
| Avg. time to fill out | 13 min 7 sec |
| Other names | ocfs forms, DEPARTMENTS, PROVIDERS, PROVIDER |
NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
PROVIDER NOTIFICATION OF LICENSING OR REGISTRATION
TO FIRE AND POLICE OR SHERIFF DEPARTMENTS
As a child day care provider you are required to give written notification concerning the location of your day care program to your local fire and police departments. If your local municipality does not have a fire or police department, the sheriff must be notified instead. This must be done within in five (5) days after receiving your license or registration. Keep a copy of the completed notification in your files and document where and when you sent the notice. You may be asked to provide proof of notification during the course of inspection of your day care program. If you have 911 in your community, you may also want to inform them. If there is any change in any of this information the appropriate local fire, police or sheriff’s departments must be notified.
COMPLETE THIS FORM AND SEND IT TO
YOUR FIRE AND POLICE OR SHERIFF DEPARTMENTS
This form may be copied
NAME OF PROVIDER/PROGRAM:
ADDRESS:
CITY/TOWN:
ZIP CODE:
PHONE NUMBER (AREA CODE):
()
I am (check one)
Day Care Center
School Age Program
Group Family Day Care Home
Family Day Care Home
I am licensed or registered to provide day care to a maximum of |
|
children who range in age |
||||
from |
|
to |
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years of age. |
|
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I provide child day care on the following days and times, (check appropriate days and write in hours of care):
Monday…………. Hours
Tuesday………… Hours
Wednesday…….. Hours
Thursday……….. Hours
Friday…………… Hours
Saturday………… Hours
Sunday………….. Hours
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
to
to
to
to
to
to
to
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
AM PM
ADDRESS OF FIRE DEPARTMENT NOTIFIED:
ADDRESS OF POLICE OR SHERIFF’S DEPARTMENT NOTIFIED:
PROVIDER’S SIGNATURE:
X
DATE:
Remember to retain a copy for your files.