ECELS- Family Child Care Health and Safety Survey

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* 1. Have you completed the ECELS Family Child Care Health and Safety self-learning module?

yes

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* 2. Address

Name

Address

Address 2

City/Town

County

ZIP/Postal Code

PA Keys registry ID Number

Email Address

Phone Number

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* 3. Are you a Neighbor / Relative or Family Child Care Provider

yes

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* 4. I am paying the review fee through

Personal Check (We will review the module when payment is received by ECELS) Make check payable to PA AAP.

Pay Pal

Money Order - Make payable to PA AAP

Other (please specify)

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* 5. I have reviewed the following print brochures / on line information.

A Child Care Provider's Guide to Safe Sleep

Back to Sleep: Tummy to Play

Safe Infant Sleep: Reducing the Risk of SIDS and Other Sleep-Related Infant Deaths

Sample Policy for Use in Child Care

Bare is Best

Learn How to Put Your Baby to Sleep Safely (3 minute video)

What Does a Safe Sleep Environment Look Like? / Safe Sleep and Your Baby

Diapering - A Dozen Common Errors

Diapering Poster

Changing Soiled Underwear

Act Early

Child Development

Infant-Toddler Resource List

Home Water Hazards for Young Children

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* 6. Have you used the Health and Safety Checklist for Home Based (Family Child Care Providers) to look for hazards in the GENERAL INDOOR AREAS checklist?

yes

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* 7. List three (3) General Indoor Areas where you found hazards that needed improvement. (See list of GENERAL INDOOR AREAS in module)

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* 8. Describe how you fixed/improved each of the area's listed above.

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* 9. List three (3) items on the TOYS and EQUIPMENT checklist where you found hazards that needed repair or improvement.

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* 10. Describe how you fixed/improved the items listed above.

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* 11. List two (2) items on the INDOOR HALLWAYS and STAIRS checklist that needed repair or improvement.

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* 12. Describe how you fixed/improved the items listed above.

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* 13. List three (3) items on the KITCHEN and FOOD PREPARATION and STORAGE AREA checklist that needed repair or improvement.

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* 14. Describe how you fixed/improved the items listed above.

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* 15. List three (3) areas on the BATHROOMS checklist that needed repair or improvement.

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* 16. Describe how you fixed/improved the items listed above.

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* 17. List one (1) item on the GARAGE and LAUNDRY AREAS checklist that needed repair or improvement.

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* 18. Describe how you fixed/improved that item.

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* 19. List three (3) items on the INDOOR/OUTDOOR and ACTIVE PLAY AREAS checklist that needed repair or improvement.

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* 20. Describe how you fixed/improved the items listed above.

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* 21. List three (3) items on the PLAYGROUND SURFACING and ACTIVE PLAY EQUIPMENT checklist that need repair or improvement.

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* 22. Describe how you fixed/improved the items listed above.

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* 23. List one (1) item on the UNSAFE ACTIVE PLAY EQUIPMENT checklist that needs repair or improvement.

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* 24. Describe how you fixed/improved that item.

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* 25. List one (1) item on the ACTIVE PLAY EQUIPMENT MAINTENANCE list that needs repair or improvement.

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* 26. Describe how you fixed/improved that item.

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* 27. List one (1) item on the ACTIVE PLAY SUPERVISION list that needs change or improvement.

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* 28. Describe how you changed or improved that item.

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* 29. List one (1) item on the SAND checklist that needs change or improvement.

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* 30. Describe how you changed or improved that item.

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* 31. List two (2) items on the SWIMMING checklist that need change or improvement.

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* 32. Describe how you changed or improved the items you listed.

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* 33. List three (3) items on the SECURITY and EMERGENCY PREPAREDNESS checklist that need change or improvement.

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* 34. Describe how you changed or improved the items you listed above.

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* 35. List three (3) items on the VEHICLES checklist that need change or improvement.

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* 36. Describe how you changed/improved each of the items listed above.

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* 37. Have you read and filled out the HAZARDS OR AREAS TO IMPROVE PLAN?

Yes

Other (please specify)

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* 38. Have you reviewed and filled out the FIRST AID KIT INVENTORY?

Yes

Other (please specify)

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* 39. Do you have current certification of successful completion of Pediatric First Aid training equivalent to the content of the course called Pediatric First Aid for Caregivers and Teachers (PedFACTs) offered by the American Academy of Pediatrics.

Yes

If no, do you intend to seek this training?