Read this first READ THIS FIRST… This document is a model health policy for child care centers in Washington State. It is written to meet Chapter 110-300 WAC (2019) and what is currently considered to be best practice standards from the American Academy of Pediatrics’ Caring for Our Children 4th edition. ** IMPORTANT INSTRUCTIONS: To meet licensing requirements, a health policy must be individualized for each child care center. This document has been formatted such that sections in red can be personalized by the center, while portions in black are considered standard language. Please pay attention to these things:  Parts labeled “click here to enter text” allow you to type information in the space.  Parts labeled “choose an item” will have drop down box – click the small arrow to the right to see the choices.  Make sure you mark any red checkboxes that apply to your center.  Black text cannot be changed. Feel free to make notes in the pink box at the end of the section if you feel there are things that do not pertain to your center or if there are additional practices not included in this document.  If you have your policy reviewed by our team (Snohomish County only), or if you contract with a nurse consultant, a nurse can modify the full document, revert all red font to black, and streamline the policy appearance. Nurses must be registered with DCYF and have contacted our program to obtain the necessary access to edit the document. Once finalized, your health policy should be personalized and reflect exactly what is done in your center. Use your health policy to train all staff and to inform parents. Call the Child Care Health Outreach Program (CCHOP) or your licensor if you have questions, or need clarification on which items are required by WAC. If your center is in Snohomish County, contact the Child Care Health Outreach Program at for assistance in completing the policy. Ask to schedule an appointment to have your policy reviewed and signed. Note: The table of contents has been set up so that it can be easily updated. Make all changes to the document, including any page breaks. When you are finished, click once somewhere in the middle of the table of contents which should select the entire table. Then right click, select “update field” and then “update entire table.” The table of contents will automatically update itself. This model health policy references various forms, logs, and other policies that are necessary for recordkeeping. Below is a list of these items. The Child Care Health Outreach Program has sample templates of all of these forms and policies. They can be accessed by visiting our website at or by clicking on the desired document link below. Email CCHOP staff at for assistance with personalizing these documents.  Model Policies – for all available model policies, see our website o o o o Pet Policy, Fish Policy, or Backyard Farm Animal Policy Pesticide Policy Disaster Plan – Child Care Center or School-age Program Bloodborne Pathogen Exposure Control Plan  Example Forms o o o o o o o o Injury/Incident Report Form (from DCYF) (PDF) Record of Injury/Illness (log) (PDF) Medication Count Verification Form (PDF) Certificate of Immunization Status CIS (from DOH) (PDF) Diaper Changing Log (PDF) Cleaning and Sanitizing Checklist (PDF) Medication Authorization Form (PDF) List of Children with Immunization Exemptions (from DOH) (PDF)  Individual Care Plans (Call or email CCHOP for copies of these documents) o Individual Plan of Care (general form) o Asthma Plan o Emergency Plan for Severe Allergies  Other Useful Documents o o o o o o Keep Me Home If Poster (PDF) Menu Planning Template (PDF) Child Care Food Transportation Temperature Log (for catered foods) (PDF) Refrigerator Temperature Log (PDF) Child Care Food Safety Temperature Log (PDF) Playground Maintenance Checklist (PDF) Health Policy Revised MM/DD/YYYY Name of Center: Click here to enter text. Address: Phone Number: Click here to enter text. Click here to enter text. City/State/Zip: Center Email Address: Click here to enter text. Click here to enter text. Center License Capacity: Click here to enter text. Participating in Early Achievers: Yes No Ages of Children: Click here to Number of Staff: Click here to enter text. enter text. Private Child Care Health Consultant/Infant Nurse Consultant name, phone, email: Click here to enter text or n/a if you do

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