Form LIC 610A at a glance
What it is: LIC 610A is the Emergency Disaster Plan for Family Child Care Homes of the California Department of Social Services, a plan that identifies resources when an emergency occurs.
Where and when to file: A copy of the form must be given to the licensing agency with the application packet. Keep Current - Return a copy to the licensing office.
Applicants need to submit a plan to handle possible emergencies.
The licensee is responsible for updating information as required, and all information should be typed or clearly handwritten.
A filled-in Form LIC 610A example: a family child care home plan
How to fill out Form LIC 610A, box by box
Licensee Name and Date
Enter the Licensee Name and the Date.
1. Emergencies, Life Threatening
Write out the home phone, the address of the home, the nearest major cross street and directions to the home from the cross street.
Call 9-1-1 and tell them the Number Calling from, the Home Address, the Major Crossroad and the Home Direction from Crossroad.
It is important to write out exactly what needs to be said to direct help to the home.
Whenever a life threatening emergency occurs, use the 9-1-1 telephone number.
Operators are able to speed dial help for any life threatening emergency. If the call is interrupted, they are usually able to identify the home address from the open line.
2. Emergency Names and Telephone Numbers
EMERGENCY NAMES AND TELEPHONE NUMBERS (In addition to 9-1-1) is a list of additional emergency resources that you may need.
Fill in Fire/Paramedics, Office of Emergency Services, Red Cross, Licensing, Ambulance, Other, Hospital, Police/Sheriff, Child Protective Services and Poison Control.
The Office of Emergency Services (OES) assists local government and the public with emergencies that threaten lives, property and the environment.
The telephone number for your local OES can be found in the white pages of the telephone book under Government Listings, County Government Offices, “Emergency Operations”. It may also be found under County Sheriff's Department.
The “Other” is extra space for other numbers that you think may be needed in an emergency.
3. Facility Evacuation
The most important action in a fire emergency is getting the children safely out and grouped together in a safe location.
Using a copy of the Facility Sketch (LIC 999A), show arrows for the safest way to exit rooms. Be sure that exit doors are not locked from the inside. In the event of a fire, get everyone out, follow the escape routes, meet at a prearranged location, account for everyone, do not let anyone return to the building and call the fire department.
As part of your application packet, you need to complete a facility sketch. Take a copy of the sketch and identify the quickest exiting routes from each room.
Copies of the exiting routes should be posted in conspicuous locations.
You also need to identify a safe location where everyone should gather to be sure everyone is counted and no one remains in the building.
You need to have regular fire drills with the children.
Your fire department is an excellent resource for fire and evacuation instructions.
4. Temporary Relocation Sites
In the event of an emergency or disaster, you need to make arrangements to move to a temporary site, such as at the home of a friend or a local church.
You need to identify a second site in the event the first site is not immediately available in the emergency.
Fill in the Name, the Phone and the Address of each temporary site.
When relocating, determine whether you need food, water, blankets and flashlight and meet at a prearranged easily accessible location.
Be sure to get permission from the property owner of the relocation site.
5. Utility Shut Off
In emergencies such as floods and earthquakes, it may be necessary to shut the utilities off.
It is important to identify the locations of the utility shut off for such emergencies.
Indicate locations on the Facility Sketch (LIC 999A) with the exit routes.
Fill in Gas, Electric and Water, each with the Gas Co. Phone, the Electric Co. Phone and the Water Co. Phone.
You should also have a wrench on hand for the gas line.
6. Equipment Location
Your home must contain a fire extinguisher and smoke detector device which meet the standards established by the State Fire Marshal.
The fire extinguisher must be in a location that is easily accessible and identified in this plan.
Fill in the Fire Extinguisher Location, the Smoke Detector Location, the Fire Alarm Location (If you have one) and the Type.
The local fire department may help you with installation information and with the location of fire equipment.
In addition to smoke alarms, you need to identify and locate any other emergency alarms that are on the premises.
If a fire is just beginning, it may be possible to extinguish the fire with a fire extinguisher. However, the children should be safely relocated before attempting to extinguish any fire.
7. Other Emergency Equipment
The plan needs to identify where this other emergency equipment is kept.
Where appropriate identify the Location of first aid kit, blankets, food and water, flashlight, radio and other emergency equipment.
In the event of a flood or earthquake, it may be necessary to have a first aid kit, blankets, food and water, radio, flashlight and other provisions.
Before you go
A copy of the form must be posted in a conspicuous place near a telephone.
Type or print clearly.
Common questions about Form LIC 610A
Where do I file it?
Keep Current - Return a copy to the licensing office.
Sources
[1] Form LIC 610A (01/22), Emergency Disaster Plan for Family Child Care Homes, California Department of Social Services (the Official source link on this page).
