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South carolina health assessment form

Dss 2926-2025

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The document is a health assessment form from the South Carolina Department of Social Services for staff involved in child care. It includes sections for personal information, medical history, physical examination results, and immunization status. The form aims to ensure that individuals working with children do not have health issues or communicable diseases that could affect their ability to provide safe care.

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Click ‘Get Form’ to open the dss 2926 in the editor.
Begin by entering your name and date of birth at the top of the form. This personal information is essential for identification.
In the 'Type of Activity in Child Care' section, check all applicable boxes that describe your role, such as 'Caring for Children' or 'Food Preparation'.
Part I requires a health professional to assess your medical history. Ensure they complete this section accurately, indicating any relevant medical issues.
In Part II, confirm that you meet the vision and hearing requirements. If corrective measures are needed, note them accordingly.
For Part III, answer whether you have any communicable diseases that could affect your ability to work in child care. Provide comments if necessary.
Finally, ensure your health care provider fills out their details, including signature and date of examination at the bottom of the form.

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2009	4.8 Satisfied (195 Votes)

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