Creating Forms for a Childcare Center

Question

For this activity, you will be creating two forms that you will need in a childcare center—a medication permission form and an accident/incident form.

Step 1: Research
Again, you may have to do a bit of research to determine what is appropriate to include on these forms. You may want to look at several websites of schools or early childcare centers to get an idea of what those organizations include in their forms. Do your due diligence to make sure the forms you create match up with common procedures other organizations use. There are just a few requirements for your Mediation Permission Form:

A section that tells parents how a caregiver will administer medications, including where medication will be held during the day and how the caregiver will give medicine to the child in a safe way.
The number for poison control, which your center would call in case of a child accidentally ingesting another child’s medication(s)—this may require some research.
Step 2: Write Forms
When you feel comfortable with the information you’ve gathered, create your forms and save them as word processing documents.

Step 3: Fill out Each Form
Imagine a sample incident (a medical incident for the medication permission form and an accident or injury for the accident/injury form). For each incident, create a copy of your medication incident form and accident/injury form, and fill them out with plausible information, as you would if you were a parent (filling out the medication permission form) or a childcare worker (accident/injury form).

To complete this activity, submit four documents:

A blank version of your medication permission form
A blank version of your accident/injury form
A filled-out version of your medication permission form
A filled-out version of your accident/injury form

Answer 1

Below are templates for a Medication Permission Form and an Accident/Incident Form, including their filled-out versions based on hypothetical scenarios. You can create these in your preferred word processing software (like Microsoft Word or Google Docs) and save them as per your requirements.

Medication Permission Form (Blank Version)

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Childcare Center Medication Permission Form

Child’s Name: ____________________________________

Date of Birth: _____________________________________

Parent/Guardian Name: ___________________________

Emergency Contact Number: ________________________

Medication Information

• Name of Medication: ___________________________________
• Dosage: __________________________________________________
• Administration Schedule: ___________________________________
• Start Date: _______________ End Date: _______________
• Reason for Medication: _______________________________________

Storage of Medication

• Medication will be securely stored in a designated area that is not accessible to children.

Administration Process:

1. Caregiver will verify the medication against the prescription label.
2. The caregiver will wash their hands before administering the medication.
3. The caregiver will provide the medication at the scheduled time directly to the child.
4. The caregiver will document the administration in the medication log.

In case of an emergency (e.g., accidental ingestion):

• Poison Control Hotline: [phone]

Consent I, the undersigned, give permission for the staff of [Childcare Center Name] to administer the above medication to my child according to the specified instructions.

Parent/Guardian Signature: ________________________

Date: _______________________________________________

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Accident/Incident Form (Blank Version)

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Childcare Center Accident/Incident Form

Child’s Name: ____________________________________

Date of Incident: ___________________________________

Time of Incident: ___________________________________

Location of Incident: ________________________________

Parent/Guardian Name: ____________________________

Emergency Contact Number: ________________________

Description of Incident:

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Actions Taken:

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Was First Aid Administered? (Yes/No)

• If yes, please describe: ______________________________________________

Staff Member Name: __________________________________

Witnesses (if any): ___________________________________

Signature of Staff Completing Report: _________________

Date: _______________________________________________

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Filled-Out Medication Permission Form

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Childcare Center Medication Permission Form

Child’s Name: Jenny Smith

Date of Birth: 01/15/2020

Parent/Guardian Name: Sarah Smith

Emergency Contact Number: [phone]

Medication Information

• Name of Medication: Amoxicillin
• Dosage: 250 mg
• Administration Schedule: Twice daily (8 AM and 8 PM)
• Start Date: 10/01/2023 End Date: 10/07/2023
• Reason for Medication: Ear infection

Storage of Medication

• Medication will be securely stored in a designated area that is not accessible to children.

Administration Process:

1. Caregiver will verify the medication against the prescription label.
2. The caregiver will wash their hands before administering the medication.
3. The caregiver will provide the medication at the scheduled time directly to the child.
4. The caregiver will document the administration in the medication log.

In case of an emergency (e.g., accidental ingestion):

• Poison Control Hotline: [phone]

Consent I, the undersigned, give permission for the staff of [Childcare Center Name] to administer the above medication to my child according to the specified instructions.

Parent/Guardian Signature: Sarah Smith

Date: 09/30/2023

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Filled-Out Accident/Incident Form

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Childcare Center Accident/Incident Form

Child’s Name: Jenny Smith

Date of Incident: 10/02/2023

Time of Incident: 10:15 AM

Location of Incident: Playground

Parent/Guardian Name: Sarah Smith

Emergency Contact Number: [phone]

Description of Incident: Jenny fell off the swing while playing. She landed on her right wrist and was crying in distress.

Actions Taken: The staff comforted Jenny and inspected her wrist, noting some swelling. First aid was administered by applying an ice pack.

Was First Aid Administered? Yes

• If yes, please describe: Ice pack was applied to reduce swelling.

Staff Member Name: John Doe

Witnesses (if any): None

Signature of Staff Completing Report: John Doe

Date: 10/02/2023

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You can adapt and format these templates as needed. Additionally, remember to replace “[Childcare Center Name]” with the actual name of your center.