Editable child care staff health assessment Forms and 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Person Examined' at the top of the form. Ensure this is printed clearly for easy reading.
3. In the 'Reason for Examination' section, select either 'Initial employment in child care' or 'Biennial re-examination' based on your situation.
4. Complete the employer section by checking all applicable activities that the individual will perform, such as 'Desk work', 'Lifting, carrying children', and others.
5. The physician or CRNP must answer questions regarding the physical examination, communicable diseases, and suitability for providing child care. Ensure they provide detailed responses.
6. For tuberculosis testing, fill in the Mantoux test date and results. If applicable, attach an official radiology report.
7. Finally, ensure that all signatures and contact information are completed before submitting the form to your organization.

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