Form LDSS-4439 at a glance
What it is: LDSS-4439 is the New York State Office of Children and Family Services Record of Evacuation Drills for Child Care Programs.
Where and when to file: Evacuation drills must be conducted at least monthly during each shift of care.
This form or an approved equivalent must be used to document evacuation drills.
A filled-in Form LDSS-4439 example: one monthly evacuation drill
How to fill out Form LDSS-4439, box by box
Program Name, License/Registration/Enrollment Number and Address
Enter the Program Name, the License/Registration/Enrollment Number and the Address.
Date/Shift Drill Start and Starting Attendance
For each drill, enter the Date/Shift, the Drill Start Time and the Starting Attendance.
Drill End and Ending Attendance
Enter the Drill End Time and the Ending Attendance. Recommend Max 2-3 minutes to complete.
Name of staff/provider conducting drill, Exit Route Followed and Comments
Enter the Name of staff/provider conducting drill.
Under Exit Route Followed, please specify: P=Primary, S=Secondary, O=Other.
The exit route must be varied to ensure that all approved means of egress are practiced.
Enter Comments.
More rules for Form LDSS-4439
All providers/staff should be able to lead during an evacuation drill.
The REVERSE has Date/Shift Drill Start, Starting Attendance, Drill End, Time, Ending Attendance, Name of staff/provider conducting drill, Exit Route, Followed and Comments.
Before you go
Evacuation drills must be conducted at least monthly during each shift of care.
Sources
[1] Form LDSS-4439 (Rev. 12/2019), Record of Evacuation Drills, New York State Office of Children and Family Services (the Official source link on this page).