Staff Health Report - Child Care Provider, DCF-F (CFS-0054). becr fill-able internet form - nwtc-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section A, PROVIDER INFORMATION. Enter the Child Care Provider's name and position title accurately.
3. Proceed to Section B for the TUBERCULOSIS TEST details. Indicate the date of the test and select the results (Positive or Negative).
4. Classify the risk level as Low or Medium. If applicable, provide results from any follow-up medical evaluations.
5. Ensure that a health professional completes and signs this section, including their address.
6. In Section C, confirm if a chest X-ray was completed and document any relevant measurements.
7. Finally, complete the PHYSICAL EXAM section by certifying that the individual is free of communicable diseases and physically able to work with children. The examining health professional must sign and date this section.

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