Form LIC 311A: Records to be Maintained at the Facility

Identification and Emergency Information - Child Care Centers (LIC 700), and Child's Pre-admission Health History Parents' Report (LIC 702).

Child's Pre-admission Health Evaluation, Physician's Report (LIC 701), if the child is not enrolled in a public or private elementary school.

Consent for Medical Treatment (LIC 627).

A written statement from parent(s) or authorized representative exempting the child from medical assessment and treatment because of adherence to a religious faith that practices healing by prayer or other spiritual means; or physician's statement that immunization is not indicated.

Confirmation of required immunization for children not enrolled in a public or private elementary school: the California School Immunization Record (CDPH 286) can be downloaded from https://www.shotsforschool.org/

A current Admission Agreement, with authorized signature(s).

Centrally Stored Medication and Destruction Record (LIC 622), if medications are handled.

Document of unusual behavior or signs of illness, special needs, and the Unusual Incident/Injury Report (LIC 624).

Signed and dated receipt of Notification of Parents' Rights (LIC 995/E).

Personal Rights - Community Care Facilities, Child Care Facilities (LIC 613A) receipts, signed and dated.

For infant centers: a quarterly infant needs and services plan, to be updated quarterly or more often as needed, signed and dated; a toilet-training plan; and an infant-feeding plan.

Authorizations for dispensing medication, signed by each child's authorized representative.

Documentation required for health-related services (e.g., blood-glucose monitoring and nebulizer care) (LIC 9166, LIC 9222).

Acknowledgement of receipt of licensing reports (LIC 9224), if applicable; Individual Infant Sleeping Plan (LIC 9227), if applicable; and Parent Consent for Administrating Medication (LIC 9221), if applicable.

Risks and Effects of Lead Poisoning (PUB 515) must be provided to parents and guardians upon enrolling or reenrolling any child in care.

Personnel Records for Licensee, Director, Assistant Director, Teachers, Teacher's Aides, Support Staff, and Volunteers, if appropriate. Documentation should be consistent with the LIC 500 and the LIS 555.

Health Screening Report Facility Personnel (LIC 503) and TB Clearance; TB Clearance and “Good Health” statement from volunteers.

Staff Immunizations (Measles, Pertussis, Influenza-May decline Influenza).

Personnel Record (LIC 501) or application/resume; Evaluation of Director Qualifications (LIC 9096); Evaluation of Teacher Qualifications (LIC 9095). For each aide under age 18, verification of high school graduation or current participation in an occupational program conducted by an accredited high school or college. For each infant center aide, verification of graduation from high school or equivalent. Education or be enrolled in course leading to graduation or have skills development potential; have experience in caring for children; verification of on-the-job training.

Criminal Record Statement (LIC 508) for staff subject to fingerprint requirements; fingerprint clearances - proof of clearance or criminal record exemption (State Criminal History, FBI, and CACI).

Appropriate driver's license for person(s) transporting children; documentation of actual hours worked.

Pediatric CPR/first aid cards for designated staff. At least one director or teacher must have the full 16 hours of health and safety training, including nutrition and lead poisoning training. (However, at child care centers for mildly ill children, the director and each fully qualified teacher must have the full 16 hours of health and safety training).

Valid water safety certificate for any adult given water-activity staffing responsibility.

Notice of Employee Rights (LIC 9052); Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).

Appropriate transcripts (official).

Verification of completing Mandated Reporter Training (renewed every 2 years) (2015 AB 1207).

Sign-in/sign-out sheets kept for current 30 days.

Admission policies, including admission criteria, ages of children who will be accepted, medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any; written inspection procedures for accepting children daily.

Designation of Facility Responsibility (LIC 308); Personnel Report (LIC 500) showing current roster.

Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).

Evidence satisfactory to the department that there is a fire escape and disaster plan, Emergency Disaster Plan (LIC 610) or equivalent, for the facility and that fire drills and disaster drills will be conducted at least once every six months. Documentation of drills shall be maintained for at least one year.

Earthquake Preparedness Checklist (LIC 9148) or equivalent, must be attached to the LIC 610 and available to the public.

Up-to-date list of qualified teacher substitutes; documentation of exceptions and waivers.

Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review).

Child Care Facility Roster (LIC 9040); Administrative Organization (LIC 309) reflecting current person(s) in charge of facility.

Facility license; Personal Rights form (LIC 613A).

Menus; daily activity schedule; Facility Sketch (LIC 999).

Child passenger restraint system poster (PUB 269) completed with local health department phone number.

Parent's Rights Poster (PUB 393); Notice of Site Visit (LIC 9213).

Any licensing report documenting a type “A” citation must be posted for 30 days.

Any licensing report or other document verifying compliance or non-compliance with the Department's order to correct a Type A deficiency must be posted for 30 days.