CCMTL 52A (Revised Forms)
Child Care Manual Transmittal Letter No. 52A
July 22, 2003
TO: All Child Care Manual Users
FROM: Thomas J. Hayes, Director
SUBJECT: Revised Forms for Child Care Centers and Type A Homes

This letter transmits revised forms to be used by Child Care Centers and Type A Homes. As a result of the implementation of the Child Care Licensing Rules (OAC Chapter 5101:2-12) on April 1, 2003, the department determined that revisions to some of the Child Care forms are needed.

As referenced in CCMTL 52, child care centers needed to begin utilizing the Incident/Injury Report JFS 01299, Employee Record Chart JFS 01306, Sleep Position Waiver JFS 01235, First Aid Supplies JFS 01244, and Center Plan of Operation JFS 01250 (for initial licensure), as soon as they were received. Of the forms requiring immediate utilization, the Incident/Injury Report JFS 01299, Employee Record Chart JFS 01306 and First Aid Supply List JFS 01244 have been revised. Please begin using the copies of these forms received with this transmittal letter, revision date 7/03. The remaining forms, in order to provide for a transition period, should begin to be implemented as soon as possible upon receipt, with full implementation expected no later than December 31, 2003. Type A Homes forms will need to be utilized as of July 1, 2003, the effective date of the Type A Homes licensing rule revision.

The following tables outline the forms included in this mailing. The tables note sample forms and required forms that have been revised, the revision made to the form and implementation date.

Please contact the Child Care Licensing Section at (614) 466-3822, should you have any questions.

Revised REQUIRED Forms included in this mailing:

Form NumberName of FormRevisionImplementation Date
JFS 01217Request for Administration of Medication (Centers and Type A Homes)Box 2 - added licensed physician, licensed dentist or advance nurse practitioner certified to administer medicine December 31, 2003
JFS 01234Child Enrollment/Health Information (Enrollment, Health, ETA, Roster Permission) (Centers and Type A Homes)Dentist - recommended for children over 18 months of age, Clarified - immunization records are not required to be on file for school childrenDecember 31, 2003
JFS 01244First Aid Supplies List (Centers and Type A Homes)Updated and Revised - tooth saver is only required for programs serving school childrenImmediate
JFS 01299Incident/Injury Report (Centers and Type A Homes)Changed Rule reference numbers under Type of Incident/Injury/otherImmediate
JFS 01303Fire Inspection Report (Centers and Type A Homes)Added space for Fire Inspector's phone numberDecember 31, 2003
JFS 01306Employee Record Chart (Centers and Type A Homes)Clarified - CPR expiration date is date to record on the chartImmediate
JFS 01313Non Conviction Statement(Centers and Type A Homes)Added check boxes to indicate Ohio Records check / FBI check requested to BCIIDecember 31, 2003

Revised SAMPLE Forms included in this mailing:

Form NumberName of FormRevisionImplementation Date
JFS 01242Medical/Dental and General Emergency Plan (Centers and Type A Homes)Revised formattingSample Form
JFS 01305Child's Medical StatementUpdated Immunization RecordSample Form


From Chapter 7 Forms and Pamphlets, please remove and file as obsolete the forms dated 4/2003 and replace with the enclosed forms dated. 7/2003.