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Division of Child Development Child Care Center Handbook

 It is important for child care providers to be knowledgeable of all of the child care requirements. Make sure you maintain current versions of the child care requirements. Rules change frequently. There are three ways to access a copy of the child care law and rules:

1.From the Division’s website at www.ncchildcare.net. The most current versions can always be found online.

2.Order a copy by completing a print materials order form. You will be charged a small fee to purchase these documents. You can request the order form from the Division or access it online.

3.You received copies when you purchase this handbook. Space is provided in the appendices to store your copy of the child care law and rules.

 Contact the Division at 919-662-4499 or 1-800-859- 0829 any time you have questions or concerns. The Division is located at 319 Chapanoke Road, Suite 120, Raleigh, NC 27603 and is open Monday through Friday from 8am to 5pm. Customer Service Representatives are available to answer questions or direct you to appropriate staff.

 Additional Child Care Provider Resources and Health and Safety Resources for Child Care are available in the resource section.

SECTION 2: MANDATORY PRELICENSING WORKSHOP

CHILD CARE RULE .0301

Attend a Prelicensing Workshop

 The operator of the child care center must complete the licensing workshop provided by the Division prior to the Division issuing an initial license or an initial Notice of Compliance to the child care center.

 The Division will provide regularly scheduled licensing workshops for new and existing child care centers to attend.

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Division of Child Development Child Care Center Handbook

 Attendance at a Prelicensing Workshop is required for the operator of a child care center. Operator is defined as the owner, director, or other person having primary responsibility for operation of the child care center subject to licensing.

 For a religious sponsored program, the pastor must attend.

 If a potential owner already operates another center, the potential operator is not required to attend the prelicensing workshop. However, the operator may want their child care director/administrator to attend.

HH –Although the operator is the only person required to attend the prelicensing workshop, the Division recommends the administrator or anyone else who will oversee the day-to-day operations of the child care business also attend the workshop.

 The prelicensing workshop is held for two consecutive days.  Workshops are conducted by representatives

from the Division.  A prelicensing workshop is held somewhere

within the state every week.  The current workshop schedule is available

from the Division by calling 1-800-859-0829, or can be accessed from the Division’s website at www.ncchildcare.net.  The cost of the two day workshop is $45.00,

which includes a copy of the child care law and rules and the Child Care Center Handbook.  The Division designed the Prelicensing

Workshop to provide operators with tools to run a successful child care business. The workshop covers:  General information about the process of

opening a child care center.  An overview of the child care requirements.  Discussion of how to initiate the licensing

process and request prelicensing consultation.  Obtain forms needed to request prelicensing

consultation.  Introduction to this handbook.

 When you attend and successfully complete the Prelicensing Workshop, you receive:

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Division of Child Development Child Care Center Handbook

 A Prelicensing Workshop Certificate that verifies you have successfully completed the mandatory two day workshop.  An application packet, which includes

instructions for completing and submitting the application.

SECTION 3: APPLICATION FOR A LICENSE

CHILD CARE RULE .0301 & .0302 Application for a License

 The individual who will be legally responsible for the operation of the center, which includes assuring compliance with the child care law and licensing requirements, must apply for a license using the form provided by the Division.

 If the operator will be a group, organization, or other entity, an officer of the entity who is legally empowered to bind the operator must complete and sign the application.

 An application packet is given to you at the Prelicensing Workshop. To initiate the prelicensing phase, you will need to complete and submit the following items to the appropriate child care licensing supervisor identified in your application packet.  An application, which is known as the Facility

Profile form (which is the first part of the application that will need to be completed)  A sample floor plan  A copy of the Prelicensing Workshop

Certificate

 There will be additional forms that you will need to complete for the application. Your child care consultant will provide these forms, the Business Operation Appendix and the Facility Statements of Responsibility, during the prelicensing phase.

 The floor plan of the center should be drawn on 8 ½ x 11 plain paper, include the dimensions of each room to be used for child care, including ceiling height, and show the locations of bathrooms, doors, and required exits. This plan should include both indoor and outdoor areas.

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Division of Child Development Child Care Center Handbook

 Upon receipt of these items, the licensing supervisor will assign a child care consultant to work with you. Your child care consultant will begin prelicensing consultation to talk about specific licensing requirements for your center.

 The child care consultant will determine which additional application forms need to be completed based on the center’s business classification. The child care consultant will provide these forms to the operator during an initial prelicensing consultation visit.

 Additional information regarding your business classification may be obtained on the NC Department of the Secretary of State’s web site at www.secretary.state.nc.us/corporations.

 A sample Application - Facility Profile form is located in the resource section. The additional application forms will be provided by the child care consultant during a prelicensing visit.

CHILD CARE RULE .0301 Prelicensing Consultation

 Anyone who wishes to obtain a license to operate a child care center must request prelicensing consultation from the Division.

 Upon receiving a request a Division representative will schedule a visit with the person requesting consultation.

 During the prelicensing phase, a child care consultant will:

 Provide technical assistance about ways for the operator to achieve and maintain compliance with child care requirements as well as consultation on best practice in the field of early care and education.

 Assess progress toward achieving satisfactory compliance of child care requirements prior to the issuance of an initial license.

 During prelicensing visits, the child care consultant will review the following:

 Child care law and rules  Available equipment and materials

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 Floor plan for indoor and outdoor areas to be used for children. Suggestions may be made to ensure the potential building design and floor plan meets early childhood practices.

 Forms and paperwork that will be used at the center

 Number of children each classroom/designated space can accommodate

 Size of the center’s indoor and outdoor areas used by children

 The operator must demonstrate the ability to comply with child care requirements prior to the issuance of a license. Once it is determined that satisfactory compliance of requirements have been met, a license will be issued. A temporary license may be issued to an operator opening a new center for six months.

 Refer to Chapter 7 – Licenses for more information on the issuance of a Temporary License.

CHILD CARE RULE .0302

Day-to-Day Operation

 The operator must demonstrate the ability to comply with the requirements for the daily operation of the child care center prior to the issuance of a license. This includes information on room arrangement, staffing patterns, equipment and supplies, in sufficient detail to show that the center will comply with applicable requirements for activities, equipment, and staff- child ratios for the capacity of the center and type of license requested.

 The potential operator needs to make the following written documents available to the child care consultant for review to verify compliance. This information is reviewed and discussed during a prelicensing visit.

 Daily Schedules  Activity Plans  Children’s Records  Discipline Policy  Incident Reports  Incident Logs  Fire Drill Records  Staff Records  Emergency Care Plan  Daily Attendance Records

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Division of Child Development Child Care Center Handbook

 Copy of certified criminal history check for operator

 Playground Inspection Reports  Record of medications administered

CHILD CARE RULE .0302 Measurements

 The child care consultant will measure all rooms to be used for child care and must assure that an accurate sketch of the center’s floor plan is part of the application packet.

 The child care consultant will enter the dimensions of each room to be used for child care, including ceiling height, and must show the location of the bathrooms, doors, and required exits on the floor plan.

CHILD CARE RULE .0302 Monitoring for Compliance

 The child care consultant will make one or more inspections of the center and premises to assess compliance with all applicable requirements.

 If the applicable requirements are met, the Division will issue a license.  If applicable requirements are not met, the child care consultant may recommend issuance

of a provisional license or may recommend denial of the application.

 A Temporary License effective for six months will be issued when satisfactory compliance of applicable requirements have been achieved.

 If a situations occurs that would change the status of a license you will need to contact your child care consultant immediately. A status change is an event that requires the issuance of a new license. Examples of a status change includes change of ownership, change in the capacity of the center, and adding or removing restrictions from a license. Refer to Chapter 7 – Licenses for specific requirements and procedures for handling a status change.

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Division of Child Development Child Care Center Handbook

SECTION 4: ADDITIONAL INSPECTIONS PRIOR TO LICENSURE

NC GENERAL STATUTE 110-91 & CHILD CARE RULE .0302 & .0401 Additional Inspection Requirements

 The potential operator must arrange for inspections of the center by the local health, building, and fire inspectors.

 The operator must provide an approved inspection report signed by the appropriate inspection to the Division representative.

 The operator is responsible for securing copies of the applicable requirements for inspections, preparing for inspections, and scheduling inspections.

 A child care consultant can help the operator identify the proper personnel in the county to contact.

 There may be a charge for an inspection in some areas. You should ask about costs at the time you schedule the inspection.

 Be aware that older buildings built before 1978 may contain hazards such as lead paint or asbestos. Common renovation activities such as sanding, cutting, painting, and demolition can create hazardous lead dust and chips by disturbing lead-based paint and other coatings, which can be harmful to children and adults. Be sure to have the building checked thoroughly before investing any money or time as these types of hazards can be costly to fix and would likely delay the opening of the child care center.

 The United States Environmental Protection Agency (EPA) requires that the “Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools” lead hazard information pamphlet be provided to owners and occupants of target housing and child-occupied facilities, and to the parents of children under age six that attend child- occupied facilities built prior to 1978.

 To get a copy of the EPA pamphlet and regulations call the NC Lead-based Paint Hazard Management Program at 919-707-5950 or visit the web site at http://www.epi.state.nc.us/epi/lead/lhmp.html.

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Division of Child Development Child Care Center Handbook

 When a center does not meet the specific building, fire, or sanitation standards, the appropriate inspector may submit a written explanation of how equivalent, alternative protection is provided. The Division will then determine if they will accept the inspector's documentation in lieu of compliance with specific standards.

 A provisional license may be issued only at the recommendation of an inspector to allow a specific time period for correcting a violation of the building, fire, or sanitation requirements, provided that the appropriate inspector documents that the violation is not hazardous to the health and safety of the children but necessitates a provisional classification until corrected.

CHILD CARE RULE .0302 & .1302

Building Inspections

 All child care centers not located in a currently occupied family residence must meet NC Building Codes for either Educational Occupancy or Institutional Occupancy.

 Potential operators are encouraged to contact their local building inspector before they make any financial commitments to build, buy or renovate a building for child care.

 Preliminary inspections are important because the site being considered may be unsuitable for child care, and a great deal of time and money could be wasted if action is taken before an inspection is completed.

 In some areas, your local building inspector will not be able to perform the preliminary inspection. You may need to contact a local building contractor or architect to help determine if the site in question would meet the appropriate building codes.

 An approved building inspection report must be submitted to the child care consultant before a license can be issued.

 You will need to contact your local inspections departments to find out if both blue prints and floor plans must be submitted and approved by them before construction or renovations begin.

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Division of Child Development Child Care Center Handbook

 Keep in mind, it is sometimes okay for an inspector to answer “no” to questions on the building inspection report and still be approved for child care. If “no” is marked, make sure the local inspector explains how the current situation at the center differs from the required code and to give his/her opinion on the safety of the building.

 After the initial building inspection, another building inspection is not required unless the operator plans to begin using space not previously approved for child care, has made renovations to the building, has added new construction, or wants to remove any restriction related to building codes listed currently on the license.

 Public school programs that will serve preschool age children must have a new building inspection conducted on the primary spaces that the programs will use. The building inspection must be completed on the form titled, Building Inspectors Inspection Form for Change of Ownership/Continued Use, provided by the Division. This inspection is required whether the preschool program is a full or part day educational program or a part time before/after school program serving preschool age children.

 Public school programs that only serve school age children are not required to submit a new building inspection report. A copy of the school’s original building inspection will be accepted to meet the child care requirements.

 The building inspection report must be completed on the form provided by the Division. Your child care consultant will either mail you this form or will deliver it when she/he makes her/his initial prelicensing visit. Sample building inspectors inspection forms are located in the resource section.

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Division of Child Development Child Care Center Handbook

CHILD CARE RULE .1304 Building Codes for Centers in a Residence

 All child care centers located in an occupied family residence and licensed for 3 - 12 children, must meet the NC Building Codes for Centers in a Residence.

 In order to be eligible to meet this section of the NC Building Codes, the operator must provide verification that the home is currently occupied as a primary residence.

 Items to verify occupancy could include a driver's license showing the address of the center, tax records, ownership of the residence, address given for military purposes, or other legal documents requested and approved by the child care consultant.

Listed below are several items that are required by NC Building Code that operators should be aware of when selecting and planning a child care center.

 All exit doors must have “single-action” locks. This is a handle or opening device that only requires one motion to operate, such as turning a doorknob or pushing a handle.

Examples of some approved door handles and locks include the following. Lever handle Single action cylindrical lock Push bar or mortise panic device Examples of some PROHIBITED door locks include the following. These types of locks cannot be used anywhere in the child care center.

Barrel bolt Dead bolt lock Chain lock

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Division of Child Development Child Care Center Handbook

 Direct exits required for all classrooms occupied by children under the age of 2.5 years.

Exit to hallway Exit to hallway

Preschool Infant/Toddler Classroom Classroom Exit to outside

Playground

 Center must meet Handicapped Accessibility Requirements.

 Your child care center must meet the requirements for handicapped accessibility even if you do not have any handicapped children enrolled.

 Check with the local inspectors for more details on the accessibility requirements.

 Additional resources on the Child Care and the Americans with Disabilities Act are located in the appendices.

 Proper location and number of toilets and sinks.

 Check with local inspectors for more details on where to locate restrooms.

 The number of sinks and toilets available in a facility may have an impact on the capacity of your center.

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Division of Child Development Child Care Center Handbook

Child Care Rule .0304 Fire Inspections

 Each child care facility must be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities established by the Department of Insurance.

 An approved fire inspection that documents that a child care center meets the appropriate NC Fire Codes is required for all child care centers.

 Each operator must schedule a fire inspection within 12 months of the center’s previous fire inspection.

 The operator is responsible for notifying the local fire inspector when it is time for the center’s annual fire inspection.

 The operator must submit the original of the completed annual fire inspection report to the child care consultant within one week of the inspection visit on the form provided by the Division.

 The fire inspection report must be submitted to the child care consultant before a license can be issued.

 A preliminary inspection is also encouraged by a local fire inspector to identify any renovations necessary to comply with the child care requirements and NC Fire Codes.

 There must be at least a manually operated fire alarm system installed in the child care center. This system must consist of an alarm bell, sending station and flashing light signal.

 An annual compliance packet, which includes a fire inspection report form, is sent to each center annually.

 A fire inspection is required annually. It is the operator’s responsibility to notify the local fire inspector when it is time for the center’s annual fire inspection.

 NC Public Schools are already required to receive fire inspections once every six months and the standards meet or exceed the child care requirements. Therefore, the Division will accept a copy of the school’s most recent fire inspection report to meet the child care requirements provided the report is dated within the last twelve months.

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Division of Child Development Child Care Center Handbook

 The inspection must be submitted on a form provided by the Division. A sample of the Child Care Fire Inspection Report is located in the resource section. The child care consultant will provide the form during prelicensing consultation.

NC GENERAL STATUTE 110-91 & Child Care Rule .0302 & .0304 Sanitation Inspections

 Each child care center must have a sanitation inspection completed prior to receiving a license and annually thereafter.

 Each center must be inspected at least annually by an Environmental Health Specialist for compliance with applicable sanitation requirements.

 Potential child care operators will need to contact the local health department.

 Plans drawn to scale and specifications for new child care centers must be submitted to the local health department for review and approval prior to initiating construction, renovations, changes to building dimensions, kitchen specifications, or other modifications to existing child care centers.

 Each center must be inspected at least annually by an Environmental Health Specialist with the local health department.

 The local Environmental Health Specialist will conduct an unannounced inspection twice a year or more often if complaints are filed.

 The completed sanitation inspection form is submitted to the Division by the local Environmental Health Specialist.

 Public school programs are required to have a sanitation inspection completed for licensure. This inspection is different from the one regularly conducted at the school. The program must meet the NC Rules Governing the Sanitation of Child Care Centers (Section .2800). The inspection must be submitted prior to the issuance of a license and annually thereafter.

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Division of Child Development Child Care Center Handbook

 The inspection must be completed on a form provided by the Environmental Health Specialist at the local county Health Department at the time of the inspection. A sample of the Sanitation Standards Evaluation Form for Child Care Centers is located in the resource section.

 Refer to Appendix C for a complete copy of Section .2800 – NC Rules Governing the Sanitation of Child Care Centers.

NC GENERAL STATUTE 110-91

Local Zoning Requirements

 All child care facilities must comply with all Federal and State Laws and local ordinances that pertain to child health, safety, and welfare.

 Local zoning ordinances must be met before a license can be issued. Potential operators should contact the local zoning and planning office in the planning stage to find out about local ordinances/restrictions for the area where the center will be located.

 Examples of local zoning ordinances/restrictions might include: provisions for the number of parking spaces, specific square footage for indoor/outdoor space, limitations of the number of children allowed, special use permit, fencing, specific landscaping, or privacy variances.

 A child care consultant can help the operator identify the proper personnel in the county to contact.

 The local zoning ordinances do not include things such as home owner association covenants or neighborhood restrictions.

SECTION 5: ON-GOING INSPECTIONS

NC GENERAL STATUTE 110-91 & Child Care Rule .0304

Building Inspection

 A new building inspection will not be required unless the operator plans to begin using space not previously approved for child care, has made renovations to the building, has added new construction, or wants to remove any restriction related to building codes currently listed on the license.

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Division of Child Development Child Care Center Handbook

 Contact your child care consultant if you plan for any of these changes to occur.

 An approved building inspection is required prior to the use of the space.

NC GENERAL STATUTE 110-91 & Child Care Rule .0304

Fire Inspections

 Each operator must schedule a fire inspection within twelve months of the center’s previous fire inspection.

 The operator is responsible for notifying the local fire inspector when it is time for the center’s annual fire inspection.

 The operator must submit the original of the completed annual fire inspection report to the child care consultant within one week of the inspection visit on the form provided by the Division.

 An annual compliance packet, which includes a fire inspection report form, is sent from the Division to each center annually.

 A fire inspection is required annually. It is the operator's responsibility to notify the local fire inspector when it is time for the center’s annual fire inspection.

 The Division will accept a copy of the public school’s most recent fire inspection report to meet the child care requirements provided the report is dated within the last twelve months.

NC GENERAL STATUTE 110-91 & Child Care Rule .0304 Sanitation Inspection

 Each child care center must be inspected at least annually by an Environmental Health Specialist for compliance with applicable sanitation requirements.

 Each center must be inspected at least annually by an

Environmental Health Specialist with the local health department.

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Division of Child Development Child Care Center Handbook

 The local Environmental Health Specialist will conduct an unannounced inspection twice a year or more often if complaints are filed.

 The Environmental Health Specialist supplies the inspection form to be completed and submits the completed form to the Division.

 Public school programs are required to have a sanitation inspection completed annually.

SECTION 6: ANNUAL LICENSE FEES

GENERAL STATUTE 110-90

Child Care License Fees

 Child care centers are required to pay an annual licensing fee, based on the permit capacity of the center.

 The fee applies to all centers except for those operating under the provisions of G.S. 110- 106, which is a religiously operated center, and publicly operated centers.

 The license fee is an annual charge to maintain a child care license for providing care for children in child care centers.

 The amount of the fee is based on the licensed capacity.

Capacity of Center Maximum Fee 12 or fewer children $52.00 13-50 children $187.00 51-100 children $375.00 101 or more children $600.00

 Licensing fee invoices are sent out in October.  The licensing fee is based on the licensed capacity of

the center as of October 1st.

 Payments may not be made in person. Payments must be mailed to the Department of Health and Human Services Controller’s Office.

 Failure to pay the annual license fee may result in the revocation of your child care license.

 Frequently asked questions regarding annual license fees requirements are listed below.

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Division of Child Development Child Care Center Handbook

The license fee was based on the capacity on your license as of October 1, 2008. The capacity change will result in a reduced license fee for the 2009 calendar year.

 I do not have the full amount of the license fee that is due. Can I make a partial payment?

The full amount of the license fee is required by the due date. Partial payment of the license fee is not acceptable, nor will payment plans be established. Administrative action may be considered if payment is not submitted in a timely manner.

 My check was dated by the due date, so why is my payment considered late?

Credit for payment will be given on the date it is received by the Division of Health and Human Services Controller’s Office, not the date on the check.

 I had my capacity changed from 75 to 50 on October 10, 2008, due to low enrollment. Why am I paying a license fee of $375.00 instead of $187.00?

Frequently Asked Questions for License Fees

 I only have 12 children enrolled in my program at present, but I am being charged for a fee of $187.00. I should only pay $52.00 according to the fee schedule.

The license fee is not based on your current enrollment. The fee is based on the licensed capacity printed on your child care license.

 My child care center has been closed since October 10, 2008. Why did I receive an invoice to pay a license fee?

All child care centers with an active status as of October 1, 2008, were sent a license fee invoice and are required to pay the fee. An annual license fee is assessed for the current calendar year. If your program would have closed on or prior to September 30, 2008, you would not have been charged a license fee for the year 2008.

 I will no longer own this child care center as of December 30, 2008. Why did I receive an invoice to pay a license fee?

If an ownership change did not occur prior to October 1, 2008, you were still considered the owner at the time of the license fee invoice; therefore you are responsible for the fee even though a new owner will acquire the center before the end of 2008. The new owner would not be billed for a license fee until October 2009.

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Division of Child Development Child Care Center Handbook

SECTION 7: RECORD RETENTION REQUIREMENTS

Child Care Rule .2318 Record Retention Requirements

 All children’s records, except medication permission slips, must be kept on file one (1) year from the date the child is no longer enrolled.

 All staff records must be kept on file one (1) year from the employee’s last date of employment.

 Current program records must be maintained on file for as long as the license remains valid.

 Prior versions of program records must be maintained based on the timeframe in the following charts:

 A minimum of thirty (30) days from the revision or replacement date:

Record Rule Activity Plan .0508 (a) Allergy Postings .0901(e) Feeding Schedule .0902 Menu .0901(b) SIDS Sleep Chart/Visual Check

.0606(a)(7)

  A minimum of one (1) year from the revision or

replacement date:

Record Rule Attendance .0302(d)(3) & .1504 Daily Schedule .0508(a) Emergency Medical Care Plan .0802(a)

Fire Drill Log .0302(d)(4) Incident Log .0802(e) Playground Inspection .0604(q) Safe Arrival and Departure Procedures

.1003(b)

 All building, fire, sanitation and swimming pool inspections must remain on file at the center as long as the license remains valid.

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 Handouts are available in the resource section to assist you in maintaining compliance with staff, program and children’s records. These handouts identify the due date, retention requirements and appropriate storage locations. Refer to Required Child Care Center Records, Required Public School Program Records and Required Public School Staff Records. A sample of each form listed on these handouts, are available throughout the handbook and on-line at www.ncchildcare.net under Providers / Provider Documents.

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Division of Child Development Child Care Handbook

Resource Section

Chapter 1: GETTING STARTED

The following pages contain resource materials discussed in or

related to the preceding chapter. Some of the resources are forms created by the Division of Child Development and must be used by licensed child care centers. Other materials are provided as a resource only for child care centers and can be used at the discretion of the center. Center operators may also wish to use this section to add any additional resource materials they have that are related to the chapter or information that is specific to their child care center.

Child Care Provider Resources

Resource and Contact Information

Child Care Resource and Referral Agencies

Technical assistance programs designed to help providers develop quality child care programs. Your local agency may also be able to assist you in finding out about local funding sources or resources to assist with program improvements. Specific programs vary by county. All counties do not have their own agency; some agencies cover multiple counties. Contact your local agency serving your area.

NC Subsidized Child Care System

Allows licensed Child Care Centers and Family Child Care Homes to receive payment for child care services provided for families who are eligible for child care subsidy services through a locally administered state-supervised voucher system. Contact your local department of social services.

Smart Start Partnerships for Children

Provides support to improve the quality, accessibility and availability of child care for NC children and families. Also provides health and family support services to ensure children are healthy and ready to succeed in school. Services vary by county. Many partnerships provide grants and technical assistance to improve the quality of care. Call 919-821-7999 or visit www.ncsmartstart.org for the name and contact of your local partnership.

Child and Adult Care Food Program (CACFP)

Provides reimbursement to licensed caregivers for meals and supplements (snacks) served to children enrolled in a Child Care Center or Family Child Care Home.

Contact information: Nutrition Services Branch, 1914 Mail Service Center, Raleigh, NC 27699-1914, Phone: 919.707.5799 or www.nutritionnc.com for information on your local contact.

Self-Help Credit Union

Provides loans to help child care providers get started, expand, buy equipment and real estate, and upgrade quality. Providers serving children receiving subsidy may qualify for a special low-interest loan program. Call 1.800.476.7428 or www.self-help.org for more information.

T.E.A.C.H. Early Childhood® Project

Comprehensive scholarships help pay the cost of tuition, books, and travel, may insure paid release time, require compensation incentives and encourage retention for child care providers working on a credential or degree in early childhood education or child development.

Child Care WAGE$® Salary supplements that are linked to the education level of participants are paid every six months as long as participants remain in child care program. T.E.A.C.H. Early Childhood® Health Insurance Program A portion of the cost of health insurance is reimbursed in child care programs that have all highly educated staff or participate in the T.E.A.C.H. Early Childhood® Project.

Contact information: Child Care Services Association 919.967.3272 or www.childcareservices.org

Child Care Provider Resources Created January 2009 for the Child Care Center Handbook

http://www.nutritionnc.com/

http://www.self-help.org/

http://www.childcareservices.org/

Child Care Provider Resources

Child Care Provider Resources Created January 2009 for the Child Care Center Handbook

Partnerships for Inclusion

Provides technical assistance to support the inclusion of young children with disabilities, ages birth through five, in all aspects of community life, including child care. Call 919.962.7356 or visit www.fpg.unc.edu/~pfi.

NC Institute for Early Childhood Professional Development

Provides information on educational opportunities and financial assistance for child care employees to improve the quality of child care. Visit www.ncchildcare.org

American Association of Poison Control Centers

Promotes the reduction of injury, illness, and death from poisonings through public and professional education and scientific research. Promotes universal access to certified regional poison centers. 1.800.222.1222 or visit their website at http://www.aapcc.org

More at Four Pre-Kindergarten Program

More at Four is a community-based education initiative designed to prepare at-risk four-year-olds in North Carolina for success in kindergarten. Pre-kindergarten classrooms are provided in diverse settings such as public and private schools, Head Start centers, and community-based child care centers and preschools. Contact the North Carolina Office of School Readiness at 919.981.5300 or visit www.osr.nc.gov/

NC Child Care Health and Safety Resource Center

Promotes safe and healthy environments for children in child care settings. Our toll free number, 1-800- 367-2229, is part of the NC Family Health Resource Line. Information, resources, and referrals to the child care communities are provided in both English and Spanish. We provide consultation and technical assistance for Child Care Health Consultants and other professionals working with child care programs. 800.367.2229 or www.healthychildcarenc.org for the name/contact of Child Care Health Consultants and for health and safety information and resource.

The National Center for Missing & Exploited Children’s (NCMEC)

The mission is to help prevent child abduction and sexual exploitation; help find missing children; and assist victims of child abduction and sexual exploitation, their families, and the professionals who serve them. Hotline:1-800-THE-LOST (1-800-843-5678) or visit www.ncmec.org/

http://www.fpg.unc.edu/%7Epfi

http://www.ncchildcare.org/

http://www.aapcc.org/

http://www.osr.nc.gov/

http://www.ncmec.org/

Health and Safety Resources for Child Care Child Care Health & Safety Buckle Up NC

www.buckleupnc.org Provides information on the use of child safety seats and seat belts, occupant restraint laws in North Carolina, as well as training opportunities and statewide resources/contacts. Carolinas Poison Center www.ncpoisoncenter.org 800-222-1222 Offers emergency telephone resource for poisoning questions and information. Consumer Product Safety Commission www.cpsc.gov 800-638-2772 TTY 800-638-8270 Lists all recalled consumer products, including toys and materials that contain lead. Emergency Preparedness in Child Care http://ncchildcare.dhhs.state.nc.us/providers/pv_em ergency.asp 800-859-0829 Provides information on emergency preparedness in child care and pandemic flu. Healthy Child Care America www.healthychildcare.org 888-227-5409 Health professionals, child care providers and families working together to improve the health and well being of children in child care settings. Healthy Childcare® www.healthychild.net Offers bimonthly publication for child care programs devoted to health and safety issues. Healthy Kids, Healthy Care® www.healthykids.us Provides parents of children who attend child care programs ways to partner with providers in the promotion of healthy and safe child care. ITS-SIDS Project http://ncchildcare.dhhs.state.nc.us/providers/pv_itss idsproject.asp Provides information about the Infant Toddler Safe Sleep and SIDS Risk Reduction in Child Care, sample forms, policies and training information.

National Resource Center for Health and Safety in Child Care and Early Education http://nrc.uchsc.edu 800-598-5437 Provides access to:  Caring For Our Children: National Health and

Safety Performance Standards for Out-of-Home Child Care

 NC Child Care Regulations NC Air Awareness Program www.ncair.org/airaware Provides educational materials and teacher resources on air quality and connects to the Air Quality Forecast. NC Child Care Health and Safety Resource Center www.healthychildcarenc.org 800-367-2229 Call for answers to child care health and safety questions. Website has information, resources, and a Directory of Child Care Health Consultants. NC Children’s Environmental Health Branch www.deh.enr.state.nc.us/ehs/Children_health/index. html Provides access to Childhood Lead Poisoning Prevention, Child Care Sanitation and School Sanitation. Prevent Child Abuse NC www.preventchildabusenc.org 800-244-53736 Offers family-oriented, community-based prevention, awareness, education, and training programs. Safe Kids USA www.usa.safekids.org Provides information to prevent accidental injury to children. Toxic Free NC www.toxicfreenc.org Provides resources for child care providers, including information about Integrated Pest Management (IPM).

http://www.deh.enr.state.nc.us/ehs/Children_health/index.html

http://www.buckleupnc.org

http://www.ncpoisoncenter.org

http://www.cpsc.gov

http://ncchildcare.dhhs.state.nc.us/providers/pv_em

http://www.healthychildcare.org

http://www.healthychild.net

http://www.healthykids.us

http://ncchildcare.dhhs.state.nc.us/providers/pv_itss

http://nrc.uchsc.edu

http://www.ncair.org/airaware

http://www.preventchildabusenc.org

http://www.usa.safekids.org

http://www.toxicfreenc.org

Child Health

American Academy of Pediatrics www.aap.org Advice about finding pediatricians, access to the Academy’s many programs, and their publications. American Heart Association www.americanheart.org 800-242-8721 Provides information on heart health, physical activity in adults and children, and getting exercise regimens into children’s lives. Center for Disease Control and Prevention www.cdc.gov CDC works to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. Center on the Social Emotional Foundations for Early Learning www.vanderbilt.edu/csefel Promotes the social emotional development and school readiness of young children birth to age 5. Healthy Smiles Healthy Children www.aapd.org/foundation The American Academy of Pediatric Dentistry’s Healthy Smiles, Healthy Children has hints and news about children’s oral health. Immunize North Carolina www.immunizenc.org 919-707-5550 The NC Immunization Branch exists to promote public health through the identification and elimination of vaccine-preventable diseases. KidsHealth www.kidshealth.org Provides doctor-approved health information about children from before birth through adolescence. NC Oral Health Section www.communityhealth.dhhs.state.nc.us/dental Provide prevention and education services on dental health for children.

Inclusion of Children with Special Needs

Asthma and Allergy Foundation of America www.aafa.org 800-727-8462 Provides information and resources on asthma and allergies.

Family Support Network of North Carolina http://fsnnc.med.unc.edu 800-852-0042 Provides family support for children with special needs through community based programs, training, and a resource directory. National Dissemination Center for Children with Disabilities www.nichcy.org 800-695-0285 (voice and TTY) Provides information on IDEA, effective educational practices, and disabilities in infants, toddlers, children, and youth. Partnerships for Inclusion www.fpg.unc.edu/~pfi Supports the inclusion of children with disabilities, from birth through age five in North Carolina. Together We Grow www.ncei.org Provides NC’s early intervention services, programs and resources for children birth through 5 years of age. The Food Allergy and Anaphylaxis Network www.foodallergy.org 800-929-4040 Provides information and resources on food allergies. Has a downloadable Food Allergy Action Plan.

Nutrition and Physical Activity

Child and Adult Care Food Program (CACFP) www.nutritionnc.com/snp/cacfp.htm Reimburses licensed caregivers for meals and snacks served to children. Eat Smart Move More www.eatsmartmovemorenc.com A statewide initiative that, through policy and environmental change, promotes increased physical activity and healthy eating. Nutrition NC www.nutritionnc.com The Nutrition Services Branch promotes sound nutrition habits for infants, children and women in their childbearing years. Has information on support for breastfeeding. Outdoor Learning Environments www.osr.nc.gov/EducRsrc/outdoorLearning.asp Provides information and resources on outdoor learning environments from the NC Office of School Readiness.

http://www.aap.org/

http://www.americanheart.org

http://www.cdc.gov

http://www.vanderbilt.edu/csefel

http://www.aapd.org/foundation

http://www.immunizenc.org

http://www.kidshealth.org

http://www.communityhealth.dhhs.state.nc.us/dental

http://www.aafa.org

http://fsnnc.med.unc.edu

http://www.nichcy.org

http://www.fpg.unc.edu/~pfi

http://www.ncei.org

http://www.foodallergy.org

http://www.nutritionnc.com/snp/cacfp.htm

http://www.eatsmartmovemorenc.com

http://www.nutritionnc.com

http://www.osr.nc.gov/EducRsrc/outdoorLearning.asp

Rev. 7.09

FOR DCD USE ONLY

ID#

COUNTY NO.

PAGE ______ OF ______

DIVISION OF CHILD DEVELOPMENT APPLICATION FOR A CHILD CARE LICENSE ________________________________________________________________

APPLICATION – FACILITY PROFILE

Profile Page Instructions:  Complete this form neatly in ink  Be sure to sign and date the form  Incomplete or incorrectly completed forms will be returned to you

1. Owner Name: ___________________________________________________________________________________

2. Facility Name: ______

3. Facility Mailing Address:

STREET/PO BOX CITY STATE ZIP CODE

4. Facility Phone Number: ( ) - Land Line/Published Unpublished Cellular Phone

5. Location Address:

STREET CITY ZIP CODE COUNTY

6. Facility Contact Person (if different from applicant):

Phone Number: (_____) ______-_________ Email Address:_______________________

Cell Phone Number: (_____) _____-________ Fax Number: (_____) _____-________

7. Requested Age Range:

8. Hours of Operation: to Days of Operation:

9. Types of care to be provided:  Full Day  Part Day  After-school

 Before/After School  Drop-in

 First Shift  Second Shift  Third Shift

10. Type of Building  New Construction  Purchasing existing child care operation

 Renovating building for child care  Other_____________________

11. Type of Facility  Family Child Care Home

 Center  Religious Sponsored Facility

12. Proposed Opening Date:________________________________________

13. Proposed number of children to be served:__________________________

Rev. 7.09

APPLICATION – FACILITY PROFILE (CONTINUED)

Type of Business Operation Check only one box:

 Sole Proprietorship: A business owned and operated by one person for profit

 General Partnership: Two or more people who carry on a business as co-owners for profit.

 Limited Partnership: Consists of two or more people who jointly own or operate a business for profit. It is similar to a general partnership except that one or more partners have limited liability and no rights to management. A limited partnership must have at least one general partner.

 Limited Liability Company: A business entity created by Statute. Owners are called members. One or more members are required to organize a limited liability company. Management of the business of the Limited Liability Company is vested in its managers.

 Corporation: An organization formed under state or federal law. It is an artificial entity legally separated from its owners.

 Non-Profit Corporation: A corporation intended to have no income or intended to have income, none of which is distributable to its members, directors, or officers.

 Government: A program operated by city, county, state, or a federal entity.

HAVE YOU, OR ANY OTHER PERSON LISTED ON THIS APPLICATION, PREVIOUSLY OPERATED A CHILD CARE FACILITY?

 Yes  No

If yes, list facility name, ID# and location: _______________________________________________________

DO YOU CURRENTLY HAVE A CHILD CARE LICENSE FOR ANOTHER LOCATION?

 Yes  No

If yes, list facility name, ID# and location: _______________________________________________________

I ATTEST, UNDER PENALTY OF PERJURY, THAT I AM (CHECK ONE OF THE FOLLOWING):  A citizen of the United States  A non citizen national of the United States  A lawful permanent resident (Alien #________________________)  An alien authorized to work (Alien # or Admission #) ___________________________ until (expiration date if applicable)  Other, please explain____________________________________________________________ Proof of residency must be verified by providing documentation such as a birth certificate, U.S. passport, Certificate of Naturalization, or U.S. Citizen Identification Card.

I certify that I have given true, accurate and complete information on this form to the best of my knowledge and I authorize investigation of all statements made on this form. I hereby certify that I do not habitually use alcoholic beverages to excess nor use illegal narcotics or other impairing drugs.

_____________________________________________________________________________

Signature of Applicant Date *An owner can submit one name in writing as a designee for the purpose of signing facility documents. (See Designee Form Letter)

*The Profile Page is completed and submitted by the applicant prior to licensure. Information may change during the licensing process.

FOR DCD STAFF USE ONLY DATE RECEIVED: / / CONSULTANT NAME: DATE OF FINAL REVIEW: / / CONSULTANT NAME: DATE REVIEWED BY SUPERVISOR: / / SUPERVISOR NAME:

FOR DCD USE ONLY

ID#

COUNTY NO.

PAGE ______ OF ______

DCD-0304 Identification # Rev. 9/08 County Date of Inspection

BUILDING INSPECTORS INSPECTION FORM FOR CHILD CARE CENTERS NAME OF OPERATION ADDRESS TELEPHONE: CITY STATE ZIP BUILDING INSPECTORS CERTIFICATE 1. The areas in the building that are designated as the licensed space are required by the licensing agency

to meet the Building Code in effect when an application for licensure is submitted to the regulating agency. Does the building listed above, to the extent observable, meet the current North Carolina Building Code? Yes____ No____

2. If no, list question numbers which do not comply, explain the violation and whether equivalent protection for the safety of the children is provided: 1) 2) 3) 4) 3 Are any of the above violations of a life safety concern? Yes No If yes, please list question numbers _______________________________ 4. In your opinion based on the violations listed above, do you recommend that the Division of Child Development issue a provisional license to allow time for correction of the violations? Yes No If yes, how long (30-60-90 days) and for which violations?

(Note: All violations must be corrected before a license can be issued unless a provisional time period is recommended or equivalent protection is documented.)

The Inspectors Certificate and Building Inspection Form is required to be completed in its entirety before the Division of Child Development (DCD) can consider the document complete. All questions must be answered; any NO answers must have a written explanation. This form was developed through the cooperation of the Division of Child Development and the Engineering Division of the Department of Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be used as a guide for the local inspector. If additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on the back of this form.

Prepare in quadruplicate: Original & copy to DCD, 1 copy kept by inspector, 1 copy kept by operator.

Identification # County Date of Inspection

CHILD CARE BUILDING INSPECTION FORM

SECTION A: The following general questions should be answered for BOTH Educational and Institutional type occupancies. LIGHT & VENTILATION 1. Is the total area of all windows in the child care room equal to or greater than 8% of the floor area or is artificial light provided? Yes No 2.a Does the room have natural ventilation from a minimum amount of operable window

or door area to the outside that would allow a clear opening that is equal to or greater than 4% or more of the floor area? (If NO, go to question 2b). Yes No

b Is space mechanically ventilated as required by North Carolina Mechanical Code? (N/A if an existing building) N/A Yes No

FIRE 3. Does this building have a manually operated fire alarm system (electrically installed system with pull box stations)? Yes No

EXITS 4. Are there at least 2 exits (doors, stairs, smoke proof towers, ramps, or horizontal exits) remote from each other on each floor or fire section of the building? Yes No 5. Is the exit capacity adequate? Yes No 6. Are all means of egress adequately illuminated at all times that the building is occupied? Yes No 7. Are the means of egress identified by readily visible exit signs when the exit or way to reach it is not immediately obvious to the occupants? Yes No 8. Is emergency power provided for centers with more than 300 occupants or for centers providing night care as required by the Building Code? N/A Yes No CORRIDORS AND ACCESS TO EXITS 9. Are all means of egress unobstructed without passing through a closet, storage area, kitchen, restroom, or other hazardous space? Yes No 10. Are all exit corridors a minimum 1-hour fire resistance? N/A Yes No (If yes, go to Question 12) (N/A applies only if there are no corridors) 11. If corridors are not 1 hour fire rated, do all child care rooms, spaces, and areas have a direct level of discharge exit to the outside? Yes No 12. a. Do all corridors, ramps, and passageways have a minimum 6 feet clear width in all areas serving as means of egress for capacity of 100 or more? (N/A if capacity is less than 100) N/A_____ Yes No b. Are all corridors, ramps, and passageways not less than 44” clear width in all areas serving as means of egress for capacity of less than 100? (N/A if capacity is more than 100) N/A_____ Yes No 13. Are all dead-end corridors no more than 20 feet in length? N/A Yes No

(N/A applies only if no dead-end occurs) 14. Do all doors have a minimum clear opening width of 32” (min. door width of 36”) in the following locations: a. between occupied rooms and required exits? Yes No b. exit doors leading to the exterior? Yes No 15. Are all doors in the line of exit travel a swinging door (side hinged)? Yes No 16. Do doors to rooms that accommodate more than 50 people swing in the direction of travel ? N/A Yes No (N/A applies if room accommodates less than 50 people) 17.a Do all required egress and exit doors have single motion, self-unlocking type handle, lever, push pad, or panic hardware? Yes No

b. If room accomdates 100 or more people, do all required egress and exit doors have push pads or panic hardware? N/A ___ Yes ____ No _____

STAIRS (NOTE: If no stairs, interior or exterior, check N/A___ and go to Question 22. If applicable, all questions must be answered) 18.a Are all stairs serving 50 or more occupants at least 44 inches in width? N/A Yes No b Are all stairs serving less than 50 occupants, at least 36” in width? N/A Yes No 19. Are all stairs with four or more steps provided with proper handrails and guardrails? Yes No 20. Are all interior stairs enclosed with 1-hour rated walls and 1-hour rated "B" labeled doors that are at least 36" wide? Yes No 21. Are the stair enclosure doors self-closing? Yes No WALLS AND CEILINGS 22. a. Are all wall and ceiling coverings throughout building non-combustible? (Use of untreated combustible fiber boards, wood, and other combustible fiber boards, wood and other combustible finishes is prohibited). Yes No_____ b. Do interior wall and ceiling finish materials meet the flame spread ratings as required by the Minimum Interior Finish Classification Table, NCBC Yes No 23. Do ceilings in habitable rooms have a minimum of 7'-6" clear height? Yes No HEATING SYSTEMS/MECHANICAL 24. Is the building free of unvented fuel burning or portable electric space heaters? Yes No 25. Have air conditioning, ventilation, heating, cooking, and other service equipment been inspected and approved by the appropriate inspectors? Yes No Date Inspected _______________________________ 26. a. Is combustion and ventilation air for boiler or heater rooms taken directly from and discharged to the outside of the building? N/A Yes No (N/A if electric heat is installed)

b. If inside air is used for fuel-burning appliance does it meet the requirements of Chapter 7 of the North Carolina Mechanical Code. N/A Yes No (N/A if inside air is not used) PLUMBING 27. Does the number of waterclosets and lavatories comply with the Plumbing Code as determined by the appropriate inspector? Yes No (1 watercloset per 15 children, 1 lavatory per 25 children)

Maximum # of persons allowed by plumbing facilities? _________ Date Inspected ELECTRICAL 28. Do the visible and accessible portions of the electrical system comply with applicable sections of the Electrical Code as determined by the appropriate inspector? Yes No Date Inspected ___________________________ MIXED AND MULTI-USE OCCUPANCIES 29. Are all child care areas separated from adjacent occupancies in accordance with the requirement of mixed occupancies and the Occupancy Separation Requirements Table? (N/A if no mixed occupancies) N/A Yes No 30. Do all multi-use areas comply with the most restrictive applicable sections of the State Building Code for each intended use? N/A Yes No (N/A if no multi-use areas) (Multi-use is defined as an area which will be used for different functions at different times and not concurrent. Example: child care to fellowship hall.) ACCESSIBILITY CODES 31. Does this building comply with applicable State Building Codes for access/use by persons with disabilities? Yes No SECTION B: The following questions should be answered only for educational occupancy in addition to the questions answered in Section A above. 32. Does the building comply with the Allowable Heights and Building Areas Table for Educational Occpancy? (If NO, go to Section C). Yes No 33. a. Are all rooms, approved for use by children below grade 2, on the level of exit discharge? (If NO go to Section C) Yes No b. Are rooms used by children in grades 2 and higher no more than one story above the level of exit discharge? Yes____ No ____ 34. a. Do rooms used by children who are less than 2 ½ years have a direct exit to the outside? (N/A applies only if center does not serve children under 2 ½ yrs) N/A____ Yes No b. Do rooms used by childen under 2 ½ years qualify as alcoves to adjacent spaces with direct exit to the outside? Yes No c. If the square footage of the child care area is >20,000 square feet, do all rooms

for all children have direct exits? (N/A if sq. footage is < 20,000) N/A ___ Yes ___ No ___ (If NO to both a and b or c, go to Section C) 35. Are all rooms approved for use by children provided with an operable window which complies with Special Exit Requirements for Educational Occupancy? N/A ___Yes No (N/A if direct exit to outside) 36. Is the most remote point in every room occupied by children, including dining room, not more than 200 feet from the nearest exterior exit ? (non-sprinklered building) Yes No 37. Are smoke detectors provided in the corridors in accordance with Automatic Fire Detection and NFPA72 for child care use? Yes No

SECTION C: The following questions should be answered only for institutional occupancy in addition to the questions answered in Section A above. 38. Does the building comply with the Allowable Heights and Building Areas Table for Institutional Occupancy? Yes No SECTION C cont.: 39. Are smoke detectors provided in the corridors in accordance with Automatic Fire Detection and NFPA72? Yes No 40. Does the building provide protection from hazardous areas as required by Special Institutional Occupancies, Group I Unrestrained Occupancies, Protection from Hazardous Areas? Yes No 41. Does the building have an approved automatic sprinkler system in accordance with Special Institutional Occupancies Group I Unrestrained Occupancies? Yes No 42. Is the most remote point in every room occupied by children, including the dining room, not more than 200 feet from the nearest exterior exit? Yes No

2008 32

DCD-0305 Identification # Rev. 9/08 County Date of Inspection

BUILDING INSPECTORS INSPECTION FORM FOR CENTERS IN A RESIDENCE LICENSED FOR

3 TO 12 PRESCHOOLERS NAME OF OPERATION ADDRESS TELEPHONE: CITY STATE ZIP BUILDING INSPECTORS CERTIFICATE 1. Buildings are required by the licensing agency to meet the Building Code in effect when an application for licensure is submitted to the regulating agency. Does the building listed above, to the extent observable, meet the current North Carolina Building Code? Yes____ No____ 2. If no, list question numbers which do not comply, explain the violation and whether equivalent protection for the safety of the children is provided: 1) 2) 3) 4) 3. Are any of the above violations of a life safety concern? Yes No If yes, please list question numbers 4. In your opinion based on the violations listed above, do you recommend that the Division of Child Development issue a provisional license to allow time for correction of the violations? Yes No If yes, how long (30-60-90 days) and for which violations?

(Note: All violations must be corrected before a license can be issued unless a provisional time period is recommended or equivalent protection is documented.)

5. Number of rooms approved for occupancy by children? (Attach sketch of building with rooms identified) 6. Specify any local zoning restriction: Signature of Inspector __________________________________________/Date Jurisdiction /Phone: The Inspectors Certificate and Building Inspection Form is required to be completed in its entirety before the Division of Child Development can consider the document complete. All questions must be answered; any NO answers must have a written explanation. Developed through the cooperation of the Division of Child Development and the Engineering Division of the Department of Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be used as a guide for the local inspector. If additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on the back of this form.

2008 33

Prepare in quadruplicate: Original & copy to Division of Child Development, 1 copy kept by inspector, 1 copy kept by operator. Identification # County Date of Inspection

CENTERS IN A RESIDENCE (3 - 12 PRESCHOOLERS) BUILDING INSPECTION FORM 1. Does the building meet the intent of the Building Code for R4 Occupancy? Yes No 2. If an addition has been built for this use, does it meet the Building Code? N/A Yes No (N/A if no new addition) 3. Do interior wall and ceiling finish materials meet the flame-spread ratings as required by the Minimum Interior Finish Classification Table, NCBC? Yes No 4. a. Does each room used for child care purposes have, on that level, access to two remotely located outside doors? Yes No ** IF answer is yes, skip to Question 5. If 4a is no, answer 4b. b. Is an exterior door located in each room used for child care purposes? Yes No ** If answer is yes, skip to Question 6. 5. Are all rooms located so as not to have a dead-end distance in excess of 20 feet? Yes No 6. Is the exit door located no more than 48" above grade? Yes No ** If answer is no, Is a ramp or pathway to grade provided? Yes ___ No ___ 7. Do all locks on doors require no more than one operation to release the door? Yes No 8. Does this building have a manually operated fire alarm system (electrically installed system with pull box stations)? Yes No 9. Are all unoccupied spaces, such as basements, laundry rooms, and fossil fuel fired furnace rooms provided with approved labeled automatic smoke and/or heat detectors? Yes No 10. Is the total area of all windows in the child care room equal to or greater than 8% of the floor area or is artificial light provided? Yes No 11. Is one-half of the window area openable, or is the space mechanically ventilated with a minimum of 5 air changes of fresh air per hour? Yes No 12. Are all fuel-burning space heaters, fireplaces, and floor furnaces, which are listed and approved, provided with a protective screen attached securely to a substantial support in such a way that children will not be burned? N/A Yes No HEATING SYSTEMS/MECHANICAL

2008 34

13. Is the building free of unvented fuel burning or portable electric space heaters? Yes No 14. Have air conditioning, ventilation, heating, cooking, and other service equipment been inspected and approved by the appropriate inspectors? Yes No 15. Is combustion and ventilation air for boiler or heater rooms taken directly from and discharged to the outside of the building (N/A if electric heat is installed)? N/A Yes No PLUMBING 16. Do the visible and accessible portions of the plumbing system comply with applicable sections of the Plumbing Code as determined by the appropriate inspector? Yes No Date Inspected ELECTRICAL 17. Do the visible and accessible portions of the electrical system comply with applicable sections of the Electrical Code as determined by the appropriate inspector? Yes No Date Inspected ___________________________ ACCESSIBILITY CODES 18. Does this building comply with applicable State Building Codes for access/use by persons with disabilities? Yes No

DCD- 0306 Identification # Rev. 09/08 County Date of Inspection

BUILDING INSPECTORS INSPECTION FORM FOR CHANGE OF OWNERSHIP/CONTINUED USE NAME OF OPERATION ADDRESS TELEPHONE: CITY STATE ZIP BUILDING INSPECTOR’S CERTIFICATE 1. For Change of Ownership and continued use, the areas in the building that are designated as the licensed space are required

by the licensing agency to meet the 2006 NC Rehabilitation Code. Does the building listed above, to the extent observable, meet the 2006 NC Rehabilitation Code? Yes____ No____

2 a For any question answered “No” but meeting prior code, list item number and attach proof of prior code certification.

Prior Code Certification Item Number Description Yes No

b. For any question answered ”No” that DOES NOT meet applicable prior code, list item number, explain the violation and whether equivalent protection for the safety of the children is provided:

Equivalent Protection Item Number Description Yes No

3 Are any of the above items of a life safety concern? Yes No If yes, please list question numbers _______________________________ 4. In your opinion based on the items listed above where prior code certification is not available, do you recommend that

Division of Child Development allow time for correction of these items? Yes No If yes, how long (30-60-90 days) and for which items? 5. Number of rooms approved for occupancy by children? (Attach sketch of building with rooms identified) 6. Specify any local zoning restriction: Signature of Inspector __________________________________________/Date Jurisdiction /Phone: Note: By signing above I acknowledge that I have seen and agree with all required prior code certification documentation.

The Inspectors Certificate and Building Inspection Form is required to be completed in its entirety before the Division of Child Development can consider the document complete. All questions must be answered; any NO answers must have a written explanation. This form was developed through the cooperation of the Division of Child Development and the Engineering Division of the Department of Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be used as a guide for the local inspector. If

Page 2 of 6

additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on the back of this form.

Prepare in quadruplicate: Original and copy to DCD, 1 copy kept by inspector, 1 copy kept by operator.

Page 3 of 6

Identification # County Date of Inspection

CHILD CARE BUILDING INSPECTION FORM

or door area to the outside that would allow a clear opening that is equal to or greater than 4% or more of the floor area? (If NO, go to question 2b). Yes No

b Is space mechanically ventilated as required by North Carolina Mechanical Code? (N/A if an existing building) N/A Yes No

FIRE 3.a What type of fire alarm system is being used? ___________________ b. Does it meet the applicable code? Yes No

EXITS 4. Are there at least 2 exits (doors, stairs, smoke proof towers, ramps, or horizontal exits) remote from each other on each floor or fire section of the building? Yes No 5. Is the exit capacity adequate? Yes No 6. Are all means of egress adequately illuminated at all times that the building is occupied? Yes No 7. Are the means of egress identified by readily visible exit signs when the exit or way to reach it is not immediately obvious to the occupants? Yes No 8. Is emergency power provided for centers with more than 300 occupants or for centers providing night care as required by the Building Code? N/A Yes No CORRIDORS AND ACCESS TO EXITS 9. Are all means of egress unobstructed without passing through a closet, storage area, kitchen, restroom, or other hazardous space? Yes No 10. Are all exit corridors a minimum 1-hour fire resistance? N/A_____ Yes No (If yes, go to Question 12) (NA applies only if there are no corridors) 11. If corridors are not 1 hour fire rated, do all child care rooms, spaces, and areas have a direct level of discharge exit to the outside? Yes No 12. a. Do all corridors, ramps, and passageways have a minimum 6 feet clear width in all areas serving as means of egress for capacity of 100 or more? (N/A if capacity is less than 100) N/A_____ Yes No b. Are all corridors, ramps, and passageways not less than 44” clear width in all areas serving as means of egress for capacity of less than 100? (N/A if capacity is more than 100) N/A_____ Yes No 13. Are all dead-end corridors no more than 20 feet in length? N/A Yes No (N/A applies only if no dead-end occurs)

Page 4 of 6

14. Do all doors have a minimum clear opening width of 32” (min. door width of 36”) in the following locations: a. between occupied rooms and required exits? Yes No b. exit doors leading to the exterior? Yes No 15. Are all doors in the line of exit travel a swinging door (side hinged)? Yes No 16. Do doors to rooms that accommodate more than 50 people swing in the direction of travel ? N/A Yes No (N/A applies if room accommodates less than 50 people) 17.a Do all required egress and exit doors have single motion, self-unlocking type handle, lever, push pad, or panic hardware? Yes No

b. If room accomdates 100 or more people, do all required egress and exit doors have push pads or panic hardware? N/A ___ Yes ____ No _____

STAIRS (NOTE: If no stairs, interior or exterior, check N/A __ and go to Question 22. If applicable, all questions must be answered) 18.a Are all stairs serving 50 or more occupants at least 44 inches in width? N/A Yes No b Are all stairs serving less than 50 occupants, at least 36” in width? N/A Yes No 19. Are all stairs with four or more steps provided with proper handrails and guardrails? Yes No 20. Are all interior stairs enclosed with 1-hour rated walls and 1-hour rated "B" labeled doors that are at least 36" wide? Yes No 21. Are the stair enclosure doors self-closing? Yes No WALLS AND CEILINGS 22. a. Are all wall and ceiling coverings throughout building non-combustible? (Use of untreated combustible fiber boards, wood, and other combustible fiber boards, wood and other combustible finishes is prohibited). Yes No_____ b. Do interior wall and ceiling finish materials meet the flame spread ratings as required by the Minimum Interior Finish Classification of the applicable code? Yes No 23. Do ceilings in habitable rooms have a minimum of 7'-6" clear height? Yes No HEATING SYSTEMS/MECHANICAL 24. Is the building free of unvented fuel burning or portable electric space heaters? Yes No 25. Have air conditioning, ventilation, heating, cooking, and other service equipment been inspected and approved by the appropriate inspectors? Yes No Date Inspected _______________________________ 26. a. Is combustion and ventilation air for boiler or heater rooms taken directly from and discharged to the outside of the building? N/A Yes No (N/A if electric heat is installed)

b. If inside air is used for fuel-burning appliance does it meet the requirements of Chapter 7 of the North Carolina Mechanical Code. N/A Yes No (N/A if inside air is not used) PLUMBING 27. Does the number of waterclosets and lavatories comply with the Plumbing Code as determined by the appropriate inspector? N/A Yes No (1 watercloset per 15 children, 1 lavatory per 25 children) Maximum # of persons allowed by plumbing facilities? _________

Page 5 of 6

Date Inspected ELECTRICAL 28. Do the visible and accessible portions of the electrical system comply with applicable sections of the Electrical Code as determined by the appropriate inspector? Yes No Date Inspected ___________________________ MIXED AND MULTI-USE OCCUPANCIES 29. Are all child care areas separated from adjacent occupancies in accordance with the requirement of mixed occupancies and the Occupancy Separation Requirements of the applicable code? (N/A if no mixed occupancies) N/A Yes No 30. Do all multi-use areas comply with the most restrictive applicable sections of the State Building Code for each intended use? N/A Yes No (N/A if no multi-use areas) (Multi-use is defined as an area which will be used for different functions at different times and not concurrent. Example: child care to fellowship hall.) ACCESSIBILITY CODES 31. Does this building comply with applicable State Building Codes for access

by persons with disabilities? Yes No SECTION B: The following questions should be answered only for educational occupancy in addition to the questions answered in Section A above. 32. Does the building comply with the Allowable Heights and Building Areas Table for Educational Occpancy? (If NO, go to Section C). Yes No 33. a. Are all rooms, approved for use by children below grade 2, on the level of exit discharge? (If NO go to Section C) Yes No b. Are rooms used by children in grades 2 and higher no more than one story above the level of exit discharge? Yes____ No ____ 34. a. Do rooms used by children who are less than 2 ½ years have a direct exit to the outside? (N/A applies only if center does not serve children under 2 ½ yrs) N/A____ Yes No b. Do rooms used by childen under 2 ½ years qualify as alcoves to adjacent spaces with direct exit to the outside? Yes No c. If the square footage of the child care area is >20,000 square feet, do all rooms

for all children have direct exits? (N/A if sq. footage is < 20,000) N/A ___ Yes ___ No ___ (If NO to both a and b or c, go to Section C) 35. Are all rooms approved for use by children provided with an operable window which complies with Special Exit Requirements for Educational Occupancy? Yes No (N/A if direct exit to outside) 36. Is the most remote point in every room occupied by children, including dining room, not more than 200 feet from the nearest exterior exit ? (non-sprinklered building) Yes No 37. Are smoke detectors provided in the corridors in accordance with Automatic Fire Detection and NFPA72 for child care use? Yes No SECTION C: The following questions should be answered only for institutional occupancy in addition to the questions answered in Section A above. 38. Does the building comply with the Allowable Heights and Building Areas Table for Institutional Occupancy? Yes No

Page 6 of 6

SECTION C cont.: 39. Are smoke detectors provided in the corridors in accordance with Automatic Fire Detection and NFPA72? Yes No 40. Does the building provide protection from hazardous areas as required by Special Institutional Occupancies, Group I Unrestrained Occupancies, Protection from Hazardous Areas? Yes No 41. Does the building have an approved automatic sprinkler system in accordance with Special Institutional Occupancies Group I Unrestrained Occupancies? Yes No 42. Is the most remote point in every room occupied by children, including the dining room, not more than 200 feet from the nearest exterior exit? Yes No For change of ownership/continued use inspections, questions answered ”No” or ”N/A” are allowable if the building met applicable code at the original time of licensure.

DCD –0303 Rev. 9/02

Prepare in triplicate – one copy retained by local fire authority and two copies given to the operator.

ADULT DAY CARE & CHILD CARE FIRE INSPECTION REPORT

COUNTY________________________ DATE OF INSPECTION ____________ Facility ID #

Please complete all items below. If not applicable, check N/A in the box with a written explanation attached.

Name of Facility_______________________________ Adult ____ Child ____ Address __________________________________________ Phone______________ City _____________________ Zip ___________ Responsible Party________________

GENERAL PRECAUTIONS: YES NO N/A 1. Attic/basement/closets/garage/furnace room & heaters clear of trash & combustible materials. 2. Clearance from ignition sources & combustible materials maintained. EMERGENCY PLANNING: YES NO N/A 3. Approved evacuation plan posted. 4. Evidence of monthly fire drills posted. 5. Record of employee training in fire prevention/evacuation & annual fire safety training on site. FIRE SERVICE FEATURES: YES NO N/A 6. Street Number posted. (Contrasting color to building & height 4” or more.) 7. Unobstructed fire apparatus road. (Width of 20’ & vertical clearance of not less than 13’6”). 8. Hydrants/Fire Department connections/control valves clear of obstructions by 3’. BUILDING SERVICES AND SYSTEMS: YES NO N/A 9. Approved heating system, listed. (No fuel burning or portable electric space heaters.) 10. Emergency lighting/exit lights in good operating order. 11. Electrical panels clear of storage. (Minimum 30”) 12. Wiring/fixtures in good condition. (Extension cords not suitable for permanent wiring.) 13. Type I hood system over all domestic cooking appliances that produce grease laden vapors. FIRE RESISTANCE RATED CONSTRUCTION: YES NO N/A 14. Required fire resistant rating maintained. (Walls, partitions, floors) 15. Door-hold open devices/automatic door closures operating properly. INTERIOR DECORATIONS & FURNISHINGS: YES NO N/A 16. No storage of clothing/personal effects in corridors & lobbies. 17. Maximum 10% of decorative materials covering walls. Does not apply to artwork & teaching material in classroom. Nothing suspended from ceiling

18. 20% maximum coverage for artwork & teaching material located on corridor walls. 19. Exits free of obstructions. FIRE PROTECTION: YES NO N/A 20. Sprinkler system maintained with annual test reports provided. 21. Smoke detector/fire alarm system maintained with annual test reports provided. 22. Approved extinguishers mounted properly & in good working order. 23. Cooking suppression systems & hood exhaust properly maintained. 24. Protective guards(such as screens) on fuel burning furnaces or fireplaces provided. MEANS OF EGRESS: YES NO N/A 25. All exits & their access (i.e. Aisles & Corridors) free of obstructions. 26. All locking devices on exit doors are of an approved type. 27. Yards & fencing to allow unobstructed exit to exterior of site. Approved for day time care only Approved for day time and night care At the time of this inspection, the fire safety conditions in this facility were found to be: _________________Satisfactory ___________________Unsatisfactory

Inspector___________________________________________ Phone ___________________

FOOD: (.2804-.2808; .2816) Demerits *01 From approved sources, free from spoilage and adulteration . 6 _________

02 Potentially hazardous food temp. 45°F (7°C) and below or 140°F (60°C) and above ....................................................... 5 _________

03 Properly prepared, packaged, and identified ......................... 4 _________ 04 Not re-served ....................................................................... 4 _________ 05 Protected at all times; access according to these rules ........... 4 _________ 06 Refrigerators with thermometers, product thermometers

provided ............................................................................... 3 _________

FOOD SERVICE EQUIPMENT AND UTENSILS: (.2809-.2814) *07 Meets specifications for refrigeration, sinks, lavatories and

dishwashing equipment according to type of service ............. 6 _________ 08 Meets specifications for other equipment and utensils,

approved material and construction, in good repair .............. 4 _________ *09 Food contact surfaces, including multi-use utensils, properly

washed, rinsed and sanitized .................................................. 6 _________ *10 Single-service articles not reused .......................................... 6 _________

11 Single-use articles not reused ................................................ 2 _________ 12 Non-food contact surfaces clean .......................................... 4 _________ 13 Equipment and utensils, including single-service articles,

protected from contamination ............................................. 4 _________ 14 Approved testing equipment for sanitizers, sanitizing

solution provided ................................................................. 3 _________

WATER SUPPLY: (.2815); DRINKING WATER FACILITIES: (.2816) *15 Supply meets 15A NCAC 18A .1700 or 15A NCAC 18C ..... 6 _________ *16 Hot water supplied and maintained in accordance with this

section. ................................................................................ 6 _________ 17 No cross connections, backflow prevention devices provided 4 _________ 18 Drinking fountains of approved type, regulated, clean .......... 4 _________

TOILET AND LAVATORY FACILITIES: (.2817-.2818) 19 Toilets and lavatories provided ............................................ 5 _________ 20 Fixtures properly sized, cleaned, sanitized, and in good repair 4 _________ 21 Potty chairs properly cleaned and sanitized .......................... 4 _________ 22 Soap, disposable towels; lavatories free of storage ................ 4 _________ 23 Handwash signs posted ......................................................... 2 _________

DIAPER CHANGING FACILITIES: [.2817-.2819; .2820 (c)] *24 Approved facilities ............................................................... 6 _________ *25 Diapering surface cleaned and sanitized after each use;

cleaning and sanitizing solutions provided ............................ 6 _________ 26 Approved diapering methods by caregivers ........................... 5 _________ 27 Test kits provided; sanitizer labeled ...................................... 3 _________ 28 Diapering surfaces free of storage, clean ............................... 2 _________ 29 Diaper changing, handwashing, and clean-up signs posted ... 2 _________

STORAGE: (.2820) *30 Medications and hazardous products properly stored and

locked .................................................................................. 6 _________ 31 Facilities provided for proper storage, kept clean ................. 3 _________

BEDS, COTS, MATS AND LINENS: (.2821) 32 Adequate beds, cots, or mats and individual linen provided .... 5 _________ 33 Beds, cots, mats properly stored, labeled, spaced during use;

good repair, clean and sanitized ............................................ 4 _________ 34 Linen clean, in good repair; properly handled and stored ........ 4 _________

*Indicates critical item (6-point demerit).

Signed __________________________________________AGENT Division of Environmental Health

FURNITURE AND TOYS: (.2822) Demerits 35 Easily cleanable construction, good repair, clean .................. 4 _________ 36 Mouth-contact surfaces cleaned and sanitized in infant and

toddler rooms ....................................................................... 4 _________ 37 Water play activity centers cleaned, sanitized and

maintained ........................................................................... 4 _________

PERSONNEL: (.2823) 38 Approved hygienic practices, clean clothes, hair restraints

where required ...................................................................... 3 _________ *39 Persons with a communicable disease or a communicable

condition shall be excluded from situations in which transmission can be reasonably expected to occur, in accordance with 15A NCAC 19A .0200 ............................... 6 _________

FLOORS, WALLS & CEILINGS: (.2824-.2825) 40 Easily cleanable, durable, good repair, clean .......................... 4 _________

*41 No identified lead poisoning hazards as defined under General Statute 130A-131.7(7) ............................................ 6 _________

LIGHTING AND THERMAL ENVIRONMENT: (.2826) 42 Maintained as required .......................................................... 4 _________ 43 Equipment clean and in good repair ...................................... 2 _________

COMMUNICABLE DISEASE CONTROL: (.2827) 44 Designated area for sick children .......................................... 5 _________

HANDWASHING: [.2828(a) and (b); .2808(c)] 45 Proper handwashing ............................................................. 5 _________

WASTEWATER: (.2829) *46 Wastewater disposed of by approved methods ...................... 6 _________

SOLID WASTES: (.2830) 47 Solid waste properly handled ................................................ 2 _________ 48 Can cleaning facilities adequate and containers kept clean .... 2 _________

ANIMAL & VERMIN CONTROL: PREMISES; OUTDOOR ACTIVITY AREA: (.2831-.2832) *49 Approved pesticides, properly used ...................................... 6 _________

50 Effective control of rodents, insects, and other vermin .......... 4 _________ 51 No animals in food preparation areas and no unrestrained

animals except as noted ....................................................... 4 _________ 52 Premises clean, drained, and free of vermin harborages and

breeding areas ....................................................................... 4 _________ 53 Equipment in good repair, sandboxes properly constructed

and clean .............................................................................. 2 _________ *54 No identified lead poisoning hazards as defined under

General Statute 130A-131.7(7) ............................................ 6 _________

SWIMMING & WADING POOLS: (.2833) *55 Designed, constructed, operated and maintained in

accordance with 15A NCAC 18A .2500 ............................... 6 _________

Classification: Superior Provisional Approved Disapproved

N.C. Department of Environment and Natural Resources Division of Environmental Health

Sanitation Standards Evaluation Form for Child Care Centers

Demerits: _____________________

Date of Insp/Chg _______________ Status Code:___________________

Health Department ________________________________

Facility ID

Old Facility ID

Licensing ID No.: ____________________________________________ Maximum Capacity: _______________ Name of Facility: _____________________________________________ Operator:__________________________________________ Address (City, Zip Code): ________________________________________________________________________________________

1 2

4 1 2

Water Supply: Community Non-Transient Non-Community Water sample taken today? Yes No Transient Non-Community Non-Public Water Supply Inspection Name Change

Re-Inspection Verification of Closure Wastewater System: Community On-Site System Visit Status Changev

DENR 1617 (Revised 8/03) Environmental Health Services Section (Review 08/06)

Purpose: General Statute 110-91 requires the Commission for Health Services to adopt standards governing the sanitation of child day care facilities. G.S. 110-93 requires the facility to submit evidence to the Department of Health and Human Services that it conforms to the standards. This form is to provide such evidence. Preparation: Local environmental health specialists shall complete the form every time an inspection is conducted and prepare an original and two copies to be submitted: 1. Original for Division of Child Development, N.C. Department of Health and Human Services. 2. Facility operator. 3. Local health department. Classification: Superior – 0-15 demerits, no 6-point demerit Approved – 16-30 demerits, no 6-point demerit Provisional – 31-45, or 6-point demerit Disapproved – 46 or more demerits, or failure to improve Provisional classification Disposition: Please refer to Records Retention and Disposition Schedule for County/District Health Departments which is published by the North Carolina Division of Historical Resources. Additional forms may be ordered from: Division of Environmental Health, 1630 Mail Service Center, Raleigh, NC 27699-1632, (Courier 52-01-00)

Required Child Care Center Records The following items must be maintained for all licensed child care programs.

When a DCD Form Number is listed, the actual DCD form must be used, otherwise, you may design your own forms.

A sample of each form is available in the Child Care Center Handbook and on-line at www.ncchildcare.net.

Storage Location Form Due Date Retention Central Classroom

Daily Schedules Day 1 1 year X Activity Plans Weekly 30 days X First Aid Information Sheet Weekly While Licensed X Safe Procedures for Pick-up & Delivery Monthly While Licensed X Menu Weekly 30 days X Fire Evacuation Routes Day 1 While Licensed X Emergency Telephone Numbers Day 1 While Licensed X Children’s Food Allergies & Special Diets Day 1 30 days X X Summary of NC Child Care Law Poster (DCD form) Day 1 While Licensed X Fire Drill reports Monthly 1 year X Emergency Medical Care Plan (DCD form) Day 1 1 year X Daily Attendance Records Daily 1 year X Safe Sleep Policy Day 1 While Licensed X Infant Sleep Check Documentation Daily 30 days X Classroom Staff to Child Ratio Sheet Day 1 While Licensed X Medicine Authorization/Administration Records As Occurs 6 months X X Incident Log (DCD form #0032) As Occurs 1 year X Building Inspection Day 1 While Licensed X Fire and Sanitation Inspections Day 1 & Annually While Licensed X Swimming Pool Inspection Day 1 While Licensed X

P R

O G

R A

M R

E C

O R

D S

Playground Safety Inspections (DCD form #0030) Monthly 1 year X

Application for Employment Day 1 1 year** X Medical Report 60 Days 1 year** X TB Test Result Day 1 1 year** X Health Questionnaire Day 1 & Annually 1 year** X Emergency Medical Care Information Day 1 1 year** X Documentation of Orientation (DCD form) First 2 & 6 weeks 1 year** X Documentation of In-service Training Annually 1 year** X Criminal Record Check Verification First 5 Days 1 year** X ITS-SIDS Safe Sleep Training Verification 4 months/3 years 1 year** X Credential/Equivalency Verification 6 Mos. 18 Mos. 1 year** X CPR & FA Verification Day 1 1 year** X Safety Training Verification 6 Mos. 1 year** X Documentation of Aquatic Activities Policy Receipt Day 1 & Annually 1 year** X Annual Staff Development Plan & Evaluations* Annually 1 year** X

S T

A F

R E

C O

R D

Documentation of Policy Receipt* Day 1 1 year** X

Application & Emergency Medical Care Information Day 1 1 year** X

Medical Exam 30 Days 1 year** X

Immunization Records 30 Days 1 year** X Documentation of Discipline Policy Receipt Day 1 1 year** X Feeding Schedules for Children under 15 Mos. Day 115 Mos. 30 days X Infant Sleep Position Waivers Day 112 Mos. 1 year** X X Documentation of Safe Sleep Policy Receipt Day 1 1 year** X Transportation Authorization Day 1/12 Mos. 1 year** X Off Premise Activity Authorization As Occurs 1 year** X Documentation of Operational Policy Receipt Day 1 1 year** X

Documentation of NC Child Care Law Receipt Day 1 1 year** X

C H

IL D

R E

N ’S

E C

O R

D S

Incident Reports (DCD form #0058) As Occurs 1 year** X

Emergency and Identification Information As Occurs 1 year** X

*Required for programs meeting voluntary enhanced standards only. **Maintain for at least one year from the date the child is no longer enrolled or from the date the employee is no longer employed. Updated 8.09

DPI_Public Schools Chapter_Resource Section Revised 09/2009

Required Public School Program Records

Record

On-Site Must be located in the

building, but not required in the

classroom

Primary Space Items that must be

located in the classroom/space used

by the children

Schedules and Activity Plans  First Aid Chart  Safe Arrival and Departure Procedures ** Menus ** Fire Evacuation Routes  Emergency Numbers  Emergency Medical Care Plan ** Children’s Allergies (post also in food preparation areas)  Summary of the NC Child Care Law ** Fire Drill Reports  Daily Attendance Records  Classroom Staff/Child Ratio Notice  Incident Reports and Incident Log  Building Inspection Documentation  Sanitation Inspection ** Copy of school Fire Inspection Report  Rating Scale Report  Monthly Playground Inspection (serving preschool children) 

**If there are multiple classrooms at an individual school that are licensed, the school may designate a central location that is prominent to all classrooms to store or post these items.

DPI_Public Schools Chapter_Resource Section Revised 07/2009

Required Public School Staff Records

Item On-Site Items that must be

maintained at the child care program

Off-Site Items that can be

stored at a location remote from the child

care program*

Employment Application  Medical Report with TB Test Results  Annual Health Questionnaires  Emergency Care Information  Documentation of Orientation  Documentation of In-Service Training  Documentation of CPR and First Aid  Criminal Record Check Verification  Credential/Equivalency Verification  Annual Staff Development Plan (for programs meeting enhanced requirements only)



Annual Staff Evaluations (for programs meeting enhanced requirements only)



Documentation of Operational and Personnel Policy Review (for programs meeting enhanced requirements only)



Documentation of Job Description Receipt (for programs meeting enhanced requirements only)



*A signed Off-Site Records Verification form must be maintained on-site at the public school program for any records stored in a remote location.

DPI_Public Schools Chapter_Resource Section Revised 07/2009

Required Public School Children’s Records

Item

On-Site Items that must be

maintained at the child care program

Off-Site Items that can be

stored at a location remote from the child

care program*

Application  Medical Exam (preschool age children only)  Immunization Records  Emergency Care Information  Documentation of Discipline Policy Receipt  Transportation and Off Premise Permission  Documentation of Receipt of Summary of Law  Incident Reports  Medication Administration Authorization and Documentation



Signed operational policy receipt statement (for programs meeting enhanced standards only)



*A signed Off-Site Records Verification form must be maintained on-site at the public school program for any records stored in a remote location.

Division of Child Development Child Care Center Handbook

Chapter 2: STAFF

Purpose Of These Requirements Staff qualifications and training requirements are essential for adults who interact with and teach children. These requirements protect children in child care facilities by ensuring these facilities provide a physically safe and healthy environment where the developmental needs of children are being met and where children are cared for by qualified staff. Staff qualifications and training requirements are important for several reasons.  Research demonstrates that college level coursework in early care and education has been

shown to have measureable, positive effects on the quality of child care.  Knowledge of brain development stages and learning methods enhances staff member’s ability

to work with young children appropriately and to the full benefit of the child.  Knowledge of infectious diseases, methods of transmitting and prevention techniques reduces

the spread of disease among children.  Knowledge of injury prevention measures controls known risks and reduces injuries among

children.  Basic first aid is essential to respond quickly to injuries and emergencies.  Management skills and training are essential for administrators to make sure there is an

efficient, safe, and motivated environment for all staff in the child care facility.  Knowledge of up-to-date training and resources on health and safety in child care settings

makes a staff member’s job easier as well as increase the level of care for children.

Definitions Article 7, Chapter 110 of the North Carolina General Statutes and Section .0100 of the Child Care Rules defines the following staff members in a child care center: Child Care Administrator: A person who is responsible for the operation of a child care center and is on-site on a regular basis as defined by the North Carolina Child Care Commission. Lead Teacher: An individual who is responsible for planning and implementing the daily program of activities and is in charge of a group of children in a child care center. Teacher: A person that assists the lead teacher in planning and implementing the daily program and at times is in charge of a group of children in the child care center. Teacher’s Aide: A person who assists the lead teacher or teacher in implementing the daily program and is supervised at all times while with a group of children in the child care center. Substitute: Any person who temporarily assumes the duties of a regular staff person for a time period not to exceed two consecutive months. Volunteer: A person who works in a child care center and is not monetarily compensated by the center.

Staff 2.1

Division of Child Development Child Care Center Handbook

 This chapter refers to several forms. A copy of each form is available in the resource section. In addition most of these forms are available on the Division of Child Development’s web site at www.ncchildcare.net under Provider Documents.

 Professional development resources have been created by the North Carolina Interagency Coordinating Council (NCICC) Professional Education Committee. Based on an analysis of requirements, standards, and needs in nine key source documents, the NCICC Professional Education Committee has identified top priorities for personnel serving young children. Use this information to plan and prioritize professional development for you and your staff.

 Professional Education for Personnel Serving North Carolina’s Young Children (0-5) www.ncei.org/ei/icc/pdf/PECpriorities2007_2009.pdf.

 What do personnel serving young children need to know? www.ncei.org/ei/icc/pdf/PECpersonnel.pdf

 To assist with creating and maintaining staff files refer to the Staff File Checklist in the resource section.

 North Carolina is the first in the nation to increase its workforce professional development standards by certifying the education of those who work with, intend to work with, and/or work on the behalf of children ages birth to twelve. For more information refer to the handouts titled, Early Education Certification (EEC) the Next Step in Professionalizing the Field and EEC Frequently Asked Questions, located in the resource section.

 Two informational handouts are available for administrators on Suggestions for Preventing Child Abuse and Child Neglect In Your Child Care Facility and Pointers for Reducing the Likelihood of Incidents of Child Abuse or Neglect in Child Care Settings. Refer to the resource section for key pointers to assist you in preventing the likelihood of child abuse or neglect occurring in your child care setting.

Staff 2.2

http://www.ncei.org/ei/icc/pdf/PECpriorities2007_2009.pdf

http://www.ncei.org/ei/icc/pdf/PECpersonnel.pdf

Division of Child Development Child Care Center Handbook

SECTION 1: PRESERVICE REQUIREMENTS FOR ADMINISTRATORS Preservice requirements are those that must be met prior to assuming a position in a child care

center. Every child care center must have someone who takes responsibility for the administration of the program and the overall care of the children.

NC GENERAL STATUTE 110-91(8) Administrator Age

 All administrators must be at least 21 years of age.

 The administrator may be the owner/operator or someone hired to work on-site and be responsible for the day to day operation of the center.

 Date of birth must be documented on an Application for Employment form to verify that an administrator is at least 21 years of age.

 A sample Application for Employment form is located in the resource section.

 Operators are encouraged to conduct a check of new or existing employees using the Department of Social Services Responsible Individuals List (RIL) of abuse and serious neglect cases. The RIL is used to identify parents, guardians, caretakers, or custodians that have been identified as responsible individuals in substantiated cases of abuse or serious neglect. Information from the RIL is available only to authorized persons for the sole purpose of determining current or prospective employment or fitness to provide care for children. The request for information from the RIL must be in writing and is available at http://info.dhhs.state.nc.us/olm/forms/dss/dss-5268-ia.pdf and in the resource section. The new or existing employee does have to sign this form to allow the information to be released to the operator.

Staff 2.3

http://info.dhhs.state.nc.us/olm/forms/dss/dss-5268-ia.pdf

Division of Child Development Child Care Center Handbook

NC GENERAL STATUTE 110-91(8) North Carolina Early Childhood Administration Credential (NCECAC)

 All administrators must have, or complete, at least a Level I NCECAC or its equivalent as determined by the Division of Child Development.

 All administrators must begin work towards a NCECAC or its equivalent within 6 months of assuming the duties of administrator.

 All administrators must complete a NCECAC or its equivalent within 2 years.

 Award of the NCECAC or its equivalent is based on completion of early childhood administration coursework, early childhood education coursework, and documentation of specific portfolio assignment requirements.

 TO APPLY TO QUALIFY AS AN ADMINISTRATOR: An administrator must submit education and equivalency (E&E) forms provided by the Division, with documentation of completion of the requirements.

 Administrators may qualify through three different levels of the NCECAC or its equivalency. They are:  Level One – Meets minimum requirements  Level Two – Meets voluntary enhanced standards  Level Three – Meets voluntary enhanced standards

 Each level has specific requirements for early childhood education coursework, administration coursework, and portfolio assignments.

 TO TEST OUT OF COURSEWORK: An administrator must submit a request to test out of administration coursework on a form provided by the Division.

 To be awarded a Level I Credential, a person must have the following education and activities:  Successfully complete EDU 261 – Early Childhood

Administration I, and EDU 262 – Early Childhood Administration II, at a local community college

 Successfully complete an additional 7 semester hours of early childhood or child development coursework at a community college or university

 Complete 6 portfolio assignments

Staff 2.4

Division of Child Development Child Care Center Handbook

 There are other combinations of education and experience that can be used as an equivalent to the above Level I requirements. The Child Care Workforce Standards Section of the Division can assist you with these options.

 Test registration information is available at www.ncchildcare.net.

 Copies of E&E forms can be found on the Division’s website at www.ncchildcare.net under Providers / Provider Documents and in the resource section.

 Complete the Workforce Change of Information (COI) Form when you need to update identifying information or educational qualifications. Refer to the copy in the resource section for further information on the use of this form.

 Refer to the informational handout on the North Carolina Early Childhood Administration Credential (NCECAC) in the resource section.

 Refer to the Guidelines to Education Evaluations for Child Care Providers in the resource section.

 Refer to the Child Care Workforce Education Evaluation: Criteria and Policy in the resource section.

 Programs wishing to have an administrator who is eligible for the most points in education standards for a Two-Five Star Rated License will want to know which level they have received. The level of an administrator’s qualification will determine the number of points you will receive in administrator education standards. Refer to Chapter 17 – Star Rated License for details.

NC GENERAL STATUTE 110-91(8) Submitting NCECAC Paperwork

 Within six months of an individual assuming child care administrator duties, each center must submit the information in the individual’s staff record regarding status of NCECAC completion.

Staff 2.5

Division of Child Development Child Care Center Handbook

 An administrator must submit an education and equivalency (E&E) form to the Child Care Workforce Standards Section of the Division.

 ITEMS TO INCLUDE IN THE STAFF FILE TO DOCUMENT STATUS OF NCECAC OR ITS EQUIVALENCY: 1. a copy of notification from the Division that the individual

meets administrator qualifications through award of the NCECAC or its equivalent

2. if the individual has not yet met the requirements then copies of any of the following paperwork should be on file:  education and equivalency form  official transcripts  enrollment in coursework  test registration forms  portfolio assessment forms

 Copies of E&E forms can be found on the Division’s website at www.ncchildcare.net under Providers / Provider Documents and in the resource section.

CHILD CARE RULE .0704 Preservice Requirements for Administrators Without a NCECAC or its

Equivalent

 All administrators must have a high school diploma or its equivalent and one of the following:  two years of full-time verifiable work experience in a licensed child care center or early

childhood work experience; or  an undergraduate, graduate, or associate degree, with at least 12 semester hours in child

development, child psychology, early childhood education or directly related field; or  a Child Development Associate Credential or completion of a community or technical

college curriculum program in the area of child care or early childhood; or  one year of full-time verifiable child care or early childhood work experience and a

North Carolina Early Childhood Credential (NCECC). AND

 Verification of having successfully completed, or be currently enrolled in, 2 semester credit hours, or 32 clock hours, of training in the area of early childhood program administration.

 Have one year experience performing administrative duties.

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 Two persons may share the position of administrator if one person meets the education and child care experience requirements (this person must be on-site and responsible for planning and implementing the daily program at the center) and the other meets the administrative experience requirements.

 If two people share the position, the person meeting the education and child care experience portions must be the one to earn the NCECAC or its equivalent.

 Experience must have been in a licensed child care facility or recognized early childhood environment.

 A directly related field may include child psychology, elementary education, special education, or human growth and development, which includes appropriate early childhood education/child development coursework.

 Administrative experience must have included the responsibility to recruit, hire, train, supervise, evaluate and dismiss staff. This experience does not have to have been in the field of child care.

SECTION 2: THE ADMINISTRATOR’S ROLE

There must be an administrator on-site at the child care center for a certain number of hours per week.

CHILD CARE RULE .0714 On-site Hour Requirements for the Administrator

 Each child care center must have an administrator on-site on a regular basis.  The number of hours is based on the licensed capacity of the center.

 The administrator is responsible for monitoring the program and overseeing administrative duties of the day-to-day operation of the center.

 Administrative duties might include conducting staff orientation and training, talking with parents, hiring, scheduling, and record keeping.

 The hourly requirements for an on-site administrator are based on an administrator’s normal working schedule and may include times when the administrator may be off-site due to administrative duties, illness, or vacation.

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Center Licensed for: less than 30 children 30 to 79 children 80 to 199 children 200 or more children

Hours On-Site: 20 hours per week 25 hours per week 30 hours per week 40 hours per week

SECTION 3: PRESERVICE REQUIREMENTS FOR LEAD TEACHERS Every group of children in a child care center must have someone who takes responsibility for

planning and implementing the daily program.

CHILD CARE RULE .0703 Lead Teacher Age

 All lead teachers must be at least 18 years of age.

 Date of birth must be documented on an Application for Employment form to verify that the lead teacher is at least 18 years of age.

 An Application for Employment form is located in the resource section.

 No one under 18 years of age may have full responsibility for or be left in charge of a group of children.

NC GENERAL STATUTE 110-91(8) & CHILD CARE RULE .0703 North Carolina Early Childhood Credential (NCECC)

 All lead teachers must have, or complete, the NCECC or its equivalent.  All lead teachers must begin work towards a NCECC or its equivalent within 6 months of

assuming the duties of lead teacher.

 All lead teachers must complete a NCECC or its equivalent within 18 months.

 Award of the NCECC is based on completion of specific early childhood coursework EDU 119 – Introduction to Early Childhood Education, or EDU 111 and EDU 112 at a local community college.

 There are other combinations of education that can be used as an equivalent to the NCECC. The Child Care Workforce Standards Section of the Division can assist you with identifying these options.

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 TO APPLY TO QUALIFY FOR LEAD TEACHER STATUS: Lead Teacher must submit an education and equivalency (E&E) form provided by the Division, with documentation of completion of requirements, or how the individual plans to complete.

 A summary handout of the Lead Teacher Equivalency Options is located in the resource section.

 Refer to Guidelines to Education Evaluations for Child Care Providers in the resource section.

 Refer to the Child Care Workforce Education Evaluation: Criteria and Policy in the resource section.

 Copies of E&E forms can be found on the Division’s website at www.ncchildcare.net under Providers / Provider Documents and in the resource section. This form only needs to be submitted to the Division once.

NC GENERAL STATUTE 110-91(8) & CHILD CARE RULE .0703

Submitting NCECC Paperwork

 Within six months of an individual assuming child care lead teacher duties, each center must submit the information in the individual’s staff record regarding status of NCECC completion.

 A lead teacher must submit an education and equivalency (E&E) form to the Child Care Workforce Standards Section of the Division.

 ITEMS TO INCLUDE IN THE STAFF FILE TO DOCUMENT STATUS OF NCECC OR ITS EQUIVALENCY: 1. A copy of notification from the Division that the individual

meets lead teacher qualifications through award of the NCECC or its equivalency

2. If individual has not yet met qualifications, then copies of any of the following paperwork must be on file:  education and equivalency form  original transcripts  national certificates

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 enrollment in coursework

 Copies of the E&E form can be found on the Division’s website at www.ncchildcare.net under Providers / Provider Documents and in the resource section.

CHILD CARE RULE .0710

Preservice Requirements for Lead Teachers Without a NCECC

 All lead teachers must have a high school diploma or its equivalent and have one of the following:

 One year experience in a licensed child care center or two years experience as a licensed family child care home operator

 Successful completion of a two year high school program of Child Care Services Occupational Home Economics

 Twenty hours of training in child development taken in the first six months of employment

 In order for a person’s work experience to count towards meeting the preservice requirements, it must have been in a licensed child care program or other legally operated child care arrangement.

 Foreign transcripts and/or degrees must be evaluated by an international education evaluation service to determine how they compare to U.S. education standards. These services can be found through an internet search for international education evaluators. A copy of this evaluation should be submitted to the Child Care Workforce Standards Section. A translation from the original language to English is not sufficient. The evaluation must detail the specific degree or education awarded and gives a breakdown in U.S. standards of the courses and the semester credit hour value. This includes a high school diploma or its equivalent, or any other coursework that is from a foreign country.

 The resource section includes a handout on Guidelines to High School Diplomas and Equivalents.

 Programs wishing to be eligible for the most points in education standards for a Two-Five Star Rated License will need lead teachers with additional education and experience. Refer to Chapter 17 – Star Rated License for details on voluntary enhanced standards for education.

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SECTION 4: THE LEAD TEACHER’S ROLE

CHILD CARE RULE .0714 On-Site Hour Requirements

 There must be a lead teacher present with each group of children for at least two-thirds of the total daily hours of operation, based on a normal working schedule.

 This requirement can be met by having one or more persons who meet the requirements for a lead teacher responsible for the same group of children.

 Hours of attendance required for lead teachers are based on a normal working schedule and may include times when the lead teacher may not be in attendance due to circumstances such as illness or vacation.

 A lead teacher can only be responsible for one group of children at a time.

 A group of children can be a classroom or a segment of a classroom as selected by the operator that does not exceed the maximum group size for the age of the children in attendance.

 Groups are determined by the group size requirements associated with staff-child ratios for each age group and space requirements for individual classrooms.

Can you explain how many hours per day a lead teacher would have to be with a group of children if the center is open from 6:30 am – 6:00 pm? In this case, the center’s total daily operating hours is 11 ½ hours. Therefore, someone meeting the requirements for a lead teacher would have to be with EACH group of children for at least 8 hours per day. Here is how this is calculated: 11½  2/3 = 7.6 (Round up to 8) or 11.5 x .666 = 7.659 (Round up to 8)

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SECTION 5: PRESERVICE REQUIREMENTS FOR TEACHERS Whenever more than one staff member works with a group of children, the person that is

responsible for assisting the lead teacher and at times is left in charge of the group is considered a teacher.

CHILD CARE RULE .0710

Preservice Requirements for Teachers Without a NCECC

 All teachers must be at least 18 years of age.  All teachers must have a high school diploma or its equivalent and have one of the following:  One year experience in a licensed child care center or two years experience as a licensed

family child care home operator;

 Successful completion of a two year high school program Child Care Services Occupational Home Economics; or

 Twenty hours of training in child development that is taken within the first six months of employment.

 Date of birth must be documented on an Application for

Employment form to verify a teacher is at least 18 years old.

 The twenty hours of child development training are in addition to the number of annual in-service training hours required for all staff.

 In order for a person’s work experience to count towards meeting the preservice requirements, it must have been in a licensed child care program or other legally operating child care arrangement.

 Foreign transcripts and/or degrees must be evaluated by an international education evaluation service to determine how they compare to U.S. education standards. These services can be found through an internet search for international education evaluators. A copy of this evaluation should be submitted to the Child Care Workforce Standards Section. A translation from the original language to English is not sufficient. The evaluation must detail the specific degree or education awarded and give a breakdown in U.S. standards of the courses and the semester credit hour value. This includes a high school diploma or its equivalent, or any other coursework that is from a foreign country.

 If a person does not meet the qualifications for a teacher, they cannot be left alone with the children and must work as an aide until they meet the qualifications.

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 An education and equivalency (E&E) form is used for documenting teacher/non lead teacher qualifications and for making an application for the equivalency options. All teachers/non lead teachers should complete and submit this form to the Division’s Child Care Workforce Standards Section within six months of hire date.

 An Application for Employment form is located in the resource section.

 The resource section includes a handout on Guidelines to High School Diplomas and Equivalents.

 Refer to Guidelines to Education Evaluations for Child Care Providers in the resource section.

 Refer to the Child Care Workforce Education Evaluation: Criteria and Policy in the resource section.

 Copies of the E&E forms can be found on the Division’s website at www.ncchildcare.net under Providers / Provider Documents and in the resource section. This form only needs to be submitted to the Division once.

 Programs wishing to be eligible for the most points in education standards for a Two-Five Star Rated License will need teachers with additional education and experience. Refer to Chapter 17 – Star Rated License for details on voluntary enhanced standards for education.

SECTION 6: PRESERVICE REQUIREMENTS FOR AIDES

A teacher’s aide is a person who assists the lead teacher or teacher in implementing the daily program and is supervised at all times while with a group of children. Whenever more than one staff member works with a group of children, the person who is responsible for assisting the lead

teacher or teacher must meet the following requirements.

CHILD CARE RULE .0710 Preservice Requirements for Teacher’s Aides

 All aides must be at least 16 years of age.  All aides must be literate.

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 Literate is defined as understanding licensing requirements and having the ability to communicate with family and relevant emergency personnel. For example, a staff person must be able to read and write English well enough to carry out all of the daily responsibilities of the position, including being able to read information on a medicine bottle, or being able to read written instructions from a parent or health care professional.

 Date of birth must be documented on an Application for Employment form to verify the teacher’s aide is at least 16 years old.

 All teachers’ aides must be directly supervised at all times by someone who meets the requirements for a lead teacher or teacher.

 An Application for Employment form is located in the resource section.

CHILD CARE RULE .0711 Preservice Requirements for Other Staff

 Any person whose job responsibility includes driving a vehicle to transport children, including any substitute driver, must meet transportation requirements in Rule .1003.

 Non-caregiving staff or any person providing support to the operation of the program must be at least 16 years of age and meet the requirements for the local health department for food handlers, if applicable, when duties are related to food preparation or food service.

 Contract people such as the music instructor who comes to the facility to teach children and contracts directly with the parent can be left alone with the children if they are in unlicensed space. The parent must sign a permission slip for this to occur. This applies even if the unlicensed space is on the premises of the facility such as a church sanctuary or the center parking lot. If the contract person is in licensed space then whether or not the parent pays or gives permission for the contract people to be left alone with the children for the service all child care requirements apply including staff-child ratios, supervision and staff qualifications.

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SECTION 7: PUBLIC SCHOOL STAFF

REQUIREMENTS FOR STAFF EDUCATION AND EXPERIENCE

 Staff in the Department of Public Instruction programs is deemed to meet or exceed all minimum licensing requirements in the child care rules.

 Verification of education and experience does not have to be presented to the Division for the issuance of a Temporary License or for one point in education standards for the issuance of a Star Rated License.

 Any public school program wishing to earn more than one point in education standards for the issuance of a Star Rated License will be required to submit verification of staff member’s education and experience using forms developed by the Child Care Workforce Standards Section of the Division.

 Once a public school program request to be assessed for a Star Rated License and more than one point in education standards, all of the preservice requirements discussed in this chapter will be monitored and must be met for all staff working with children in the program.

 Refer to Chapter 17 – Star Rated License for staff education requirements for a Star Rated License.

 A copy of the Public School Preschool Staff Education Form for Administrators and Public School Preschool Staff Education Form for Teacher/Teacher Assistant is located in the resource section and also available on the Division web site www.ncchildcare.net under Providers / Provider Documents.

SECTION 8: SUBSTITUTES AND VOLUNTEERS

A substitute is any person who temporarily assumes the duties of a staff person for a time period not to exceed two consecutive months. All of the following requirements apply to this person. A volunteer is a person who works in a child care facility and is not monetarily compensated by the

facility.

CHILD CARE RULE .0702 Requirements for Substitutes

 All substitutes must be at least 18 years of age and literate.

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 Date of birth must be documented on an Application for Employment form to verify the substitute is at least 18 years of age.

 A substitute must be at least 18 years of age if they are left in charge of a group of children.

 A substitute may only fill in for a regular staff member for two months. After this time, a qualified person must be hired.

 A copy of the Application for Employment form is located in the resource section.

CHILD CARE RULE .0702 & .0703 Requirements for Volunteers

 No one under 18 years of age can have full responsibility for or be left in charge of a group of children.

 A volunteer who is at least 13 years of age, but less than 16 years of age, may work in a child care center on a volunteer basis, as long as he or she is supervised by and works with a required staff person who is at least 21 years of age, and also meets the health standards found in Rule .0702 for volunteers.

 No one younger than 16 years old can be left alone with children nor counted toward meeting the required staff-child ratio.

 Date of birth must be documented on an Application for Employment form to verify the substitute is at least 18 years of age.

 A copy of the Application for Employment form is located in the resource section.

SECTION 9: CRIMINAL RECORD BACKGROUND CHECKS FOR STAFF Article 7, Chapter 110, Section 90.2 of the NC General Statutes requires criminal record checks for all child care operators, caregivers and other staff members in a licensed or regulated child

care facility.

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NC GENERAL STATUTE 110-90.2 Mandatory Child Care Provider Criminal Record Checks

 A criminal history check must be conducted on all persons who provide child care in a licensed or regulated child care facility.

What must be done?

1. All staff members must receive and complete the Child Care

Mandatory Notice Criminal History Check and Prior Conviction/Pending Indictment Statement form. This form must remain in the employee’s personnel file and is not to be mailed to the Division.

2. There are specific items that need to be completed for submission to the Division of Child Development.

 Local criminal history check report from the clerk of superior court

 1 completed fingerprint card  Identifying information form (often called the bubble

sheet form) with signed Authority for Release of Information Statement

 The local criminal history check report must be a certified, original copy from the Clerk of Court’s office in the applicant’s county of residence. This local criminal history check must be done within 90 days of the date the forms are mailed to the Division.

 Staff members must submit one local criminal history check from all counties where the person has resided during the previous 12 months, including counties in another state.

 A fingerprint card must be completed using SBI form FD-258 for a State Bureau of Investigation (SBI) check. If the person has not lived in North Carolina for the last five (5) consecutive years, a state (SBI) and national (FBI) check will be completed.

 Fingerprints may also be submitted via Live Scan technology. Call the Department of Health and Human Services Criminal Record Unit at 919-773-2856 or 1-800-859-0829 (in State calls only) for details.

 The Authority for Release of Information Statement must be signed by each staff member. The statement is found on the back of the Identifying Information Sheet (bubble sheet).

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 A sample Child Care Provider Mandatory Notice Criminal History Check with Prior Conviction/Pending Indictment Statement is located in the resource section. Instructions for the Mandatory Notice Statement can be found on the back of this form.

 A sample fingerprint card is available in the resource section. Instructions for completing the fingerprint card are located on the back of this form.

 Criminal Record Background Check Basic Instructions (Including forms and approved county list for electronic printing) and Supplemental Instructions for Potential Owner/Operator of a Licensed Child Care Facility or Religious Sponsored Child Care Facility are available in the resource section.

 Additional forms are required for Live Scan technology (electronic fingerprinting). Refer to the Applicant Information form and Electronic Fingerprint Submission Release of Information form in the resource section for details.

 Most of the forms listed above are also available on the Division’s website at www.ncchildcare.net. Click on the DHHS Criminal Record Checks tab.

 Staff in public school programs that had a background check conducted at the time of their employment with the school system will not have to complete a separate background check for the Division.

 The public school system must verify that a background check was conducted for all staff.

 The school must record the information on background checks on the Criminal Record Check Verification form that is available in the resource section. This form must be submitted to the address located at the bottom of the form.

 If the school system has a current employee that has never had a background check completed, one must be completed according to the school system’s current procedures prior to the issuance of a license.

 If the school system does not currently require any type of background checks, the check must be conducted by the Division according to the child care law and rules outlined within this chapter.

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For the purpose of criminal record checks only, who is considered a staff member?  Staff members include owners, administrators, lead teachers,

teachers, teacher’s aides, cooks, substitutes, van drivers, and others in contact with the children on a regular basis. It also includes the chief executive officer (CEO) or other person serving in like capacity designated by the CEO as responsible for the operation of the facility as well as the person signing the Letter of Intent for religious sponsored child care programs.

 Staff in a licensed public school program may consist of the administrator, teachers, teacher’s assistants, program coordinators, and group leaders assigned to groups of children. Staff may also include substitutes and volunteers that work in the school and are counted in the required staff-child ratios for the licensed public school program. It would not include auxiliary staff members such as Art, Gym, or Music teachers, even if they were counted in the staff-child ratios.

CHILD CARE SECTION .2700 Requirements for Criminal Record Checks

 Substitutes who work more than five days at a center must submit a background check. The five days are cumulative rather than consecutive.

 Copies of all background check forms must be kept in the employee’s file until the qualification letter is received.

 Forms must be completed within five (5) business days of the fifth day working at a child care center and submitted to the Division within three (3) business days of receipt by employer.

 Completed forms for each new staff member must be submitted to the Division no later than eight (8) business days after beginning work.

 The Division will not accept an incomplete packet or items mailed separately.

HH -Even though volunteers are not required by the Criminal Record Check law to submit a background check, an operator may want to request a local criminal history check to review.

 Pending charges or a conviction does not mean the Division will automatically disqualify the individual.

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 If an individual has a conviction, has a pending charge or indictment, is under deferred prosecution, received a Prayer for Judgment, or is on probation for a crime, he or she may submit additional information to the Division for consideration.

 Even if the Division qualifies an individual with a conviction, the operator can still choose not to hire or continue to employ the individual if that is their policy.

 If a new employee is hired and he/she has already received a “Qualification Letter” while working at another child care center and it is less than 12 months old, only a new local history check and a new Identifying Information Sheet need to be submitted.

 If the Qualification Letter is more then 12 months old, the entire criminal background check process must be completed.

 All child care operators, staff members, and household members that remain at the facility for three (3) consecutive years after qualification must submit a form provided by the Division for a modified criminal record check on each three (3) year anniversary date of employment.

 Refer to the Criminal Record Background Check Basic Instructions for Regulated Programs for information on completing a three year re-check for qualification.

 Use the Checklist for Child Care Providers to assist in submitting criminal record check documents to the Division.

 Use the General Information for Child Care Providers summary and post as a reference.

GENERAL STATUTE 110-91(8)

 No person can be an operator of nor be employed in a child care facility who has been convicted of a crime involving child neglect, child abuse, or moral turpitude, or who is an habitually excessive user of alcohol or who illegally uses narcotic or other impairing drugs, or who is mentally or emotionally impaired to an extent that may be injurious to children.

 No staff member, caregiver or administrator of any facility shall be under the influence of alcohol, illegal drugs or prescription drugs not prescribed for that person.

HH – Child care operators should consider conducting random drug testing.

HH – The Division conducts criminal history checks every 3 years. Operators may request staff to provide a local criminal record check annually or as needed.

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SECTION 10: HEALTH REQUIREMENTS FOR STAFF Any person seeking a position with a child care center must meet medical and health standards.

For the purpose of health standards only, who is considered a staff member?  The staff of a child care center may consist of the administrator, lead teachers, teachers,

teacher’s aides, cooks, transportation personnel, and any other persons who come in contact with the children on a regular basis. This also includes any substitutes and volunteers that work in a center and are counted in the required staff-child ratios.

CHILD CARE RULE .0701 Initial Health Standards for Staff

 All staff must have on file within 60 days of the date of employment, a statement signed by a licensed physician or an authorized health professional under his/her supervision, that indicates that the person is emotionally and physically fit to care for children.

 The medical statement must indicate the person is emotionally and physically fit to care for children.

 The medical statement must be on file at the child care center within 60 days of the staff member's date of employment at the center.

 It is a good policy to have a regularly scheduled review and update of these forms to make sure you have the most recent information on each staff.

 A sample Staff Medical Report is located in the resource section.

 For licensed public school programs, the Division will accept a copy of a medical statement that was completed at the time of employment or one that has been completed at some time during employment with the public school system.

 The medical report does not have to be kept on-site at the licensed program. However, the Public School Off-Site Records Verification form must be on-site that identifies the storage location, name, and contact information of the individual responsible for maintaining the record, and a statement that the record is on file and contains the appropriate information. This form is available in the resource section.

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CHILD CARE RULE .0701 Initial Health Standards for Staff

 A test showing each employee, including the administrator, to be free of active tuberculosis is required prior to employment.

 The TB test must show the person is free of active tuberculosis.  TB test results must be on file at the center on the first day the

staff member (including substitutes or volunteers) begins work at the center.

 TB test results must be less than 12 months old at the time of employment.

 A sample Tuberculosis (TB) Test form is located in the resource section.

 For licensed public school programs, the Division will accept a copy of a negative TB test result that was completed at the time of employment or one that has been completed at some time during employment with the public school system.

 The TB test results do not have to be kept on-site at the licensed program. However, the Public School Off-Site Records Verification form must be on-site that identifies the storage location, name, and contact information of the individual responsible for maintaining the record, and a statement that the record is on file and contains the appropriate information. This form is available in the resource section.

CHILD CARE RULE .0701 Initial Health Standards for Staff

 All staff must have emergency medical care information on file.

 Emergency medical care information must be on file at the center on the first day the staff member begins work at the center.

 The emergency medical care information must include emergency contact information for the person.

 Emergency information must include: 1. Name, address, telephone number of a person to contact in

case of emergency

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2. Health care provider of choice for the staff member 3. Hospital choice for the staff member 4. Chronic illnesses and medications currently being taken by

staff member 5. Other information that may impact safe medical treatment

for the staff member in case of emergency.

 A sample Emergency Information on Staff (top half) and Health Questionnaire (bottom half) form is located in the resource section.

 The emergency medical care information for public school staff MUST be kept on-site at the licensed public school program.

CHILD CARE RULE .0701 On-going Health Standards for Staff

 Each staff member must submit annually a health questionnaire giving information about the status of his/her health.

 The health questionnaire must be completed once a year for every staff member after the first year of employment.

 The health questionnaire must be on forms supplied by the Division.

 The Division can request a medical or health questionnaire to be completed at any time when there are concerns with the status of a staff member’s health.

 A sample Emergency Information on Staff (top half) and Health Questionnaire (bottom half) form is located in the resource section.

 After the first year of employment and/or licensure of the public school program, each staff member must complete the Staff Health Questionnaire. The health questionnaire does not have to be kept on-site. However, the Public School Off-Site Records Verification form must be on-site that identifies the storage location, name, and contact information of the individual responsible for maintaining the record, and a statement that the record is on file and contains the appropriate information. This form is available in the resource section.

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CHILD CARE RULE .0702 Health Standards for Substitutes and Volunteers

 All substitutes and volunteers not counted in the staff-child ratios must complete a health questionnaire prior to the first day of work.

 A test showing each substitute and volunteer to be free of active tuberculosis is required prior to the first day of work.

 Emergency medical care information must be on file for each substitute or volunteer prior to the first day of work.

 The health questionnaire must give information about the status of the person's health.

 The emergency medical care information must include emergency contact information for the person.

 Substitutes and volunteers counted in the staff-child ratios must comply with health standards contained in Rule .0701.

 The health questionnaire must be completed on the first day at the center for all substitutes and volunteers and must completed annually thereafter as long as they continue to work in the center.

 Emergency medical care information must be on file at the center on the first day the center for all substitutes and volunteers.

HH - It is a good policy to have a regularly scheduled review and update of these forms to make sure you have the most recent information on each staff.

 A sample Emergency Information on Staff (top half) and Health Questionnaire (bottom half) form is located in the resource section.

SECTION 11: HEALTH AND SAFETY TRAINING REQUIREMENTS

The staff of a child care center is charged not only with the safety of the children in care, but also with the quality of care children receive. Initial and on-going training is required of all staff members. The amount and scope of this training may vary depending on positions held at the

center.

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CHILD CARE RULE .0705 Cardiopulmonary Resuscitation (CPR) Training for Staff

 Each child care center must have at least one person on the premises at all times, and at least one person who accompanies the children whenever they are off the premises, who has successfully completed a cardiopulmonary resuscitation (CPR) course within the last 12 months. The CPR course must be taught by either the American Red Cross, American Heart Association or other organizations approved by the Division.

 CPR training must be renewed on or before the expiration of the certification or every two (2) years, whichever is less.

 “Successfully completed” is defined as demonstrating competency, as evaluated by the instructor, in performing CPR.

 Each type of CPR course covers a different age range. The staff member’s certification must be appropriate for the ages of children in care. Be sure to verify the age range of the courses completed. At least one staff member must be certified appropriately for the ages of children in care.

 Proof of an appropriate CPR training is a course completion card.

 Having additional staff trained in CPR will ensure that you have complete coverage in the event of absences or vacation, or staff turnover.

 Documentation of successful completion of the course from the American Heart Association, American Red Cross, or other organization approved by the Division must be on file at the center.

 CPR training cannot be counted toward meeting annual in- service training hours for staff required to receive less than 20 hours of annual training. Refer to Section 13 of this chapter for more information on in-service training requirements.

 Refer to the resource section for CPR and First Aid Training Information, which includes a list of organizations that are recognized by the Division as an acceptable training agency for CPR and First Aid training (as of July 1, 2008).

 For licensed public school programs, verification of CPR training must be maintained on-site at the licensed public school program.

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CHILD CARE RULE .0705 First Aid Training for Staff

 Staff who have completed a course in basic first aid must be present at all times children are present.

 First aid training must be renewed on or before the expiration of the certification, or every three (3) years, whichever is less.

 The basic first aid course must address principles for responding to emergencies, and techniques for handling common childhood injuries, accidents, and illnesses such as choking, burns, fractures, bites and stings, wounds, scrapes, cuts and lacerations, poisoning, seizures, bleeding, allergic reactions, eye and nose injuries and sudden changes in body temperature.

 A staff member who has completed first aid training must also accompany children participating in off premise activities and when children are being transported.

 The number of staff members required to have first aid training is dependent on the number of children present at the center.

Number of Children # of staff with First Aid 1-29 1 30-79 2 80 + 3

 Verification of each required staff person’s completion of the first aid training must be maintained in the person’s individual personnel file in the center.

 Having additional staff trained in first aid will ensure that you have complete coverage in the event of absences or vacations, or staff turnover.

 First Aid training can only be counted toward meeting annual in-service training hours every three years.

 For licensed public school programs, verification of first aid training must be maintained on-site at the licensed public school program.

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CHILD CARE RULE .0705 Communicable Disease Training for Staff

 At least one staff person must be knowledgeable of and able to recognize common symptoms of illness.

 Documentation of the type and date of the training must be on file at the center.

 Contact a local Child Care Health Consultant to find out about training opportunities in your area, visit the Child Care Health and Safety Resource Center’s web site at www.healthychildcarenc.org for a listing of child care health consultants by county or call the Resource Center at 1-800- 367-2229.

CHILD CARE RULE .0705 Playground Safety Training for Staff

 Staff must complete at least four (4) clock hours of training in safety.

 This training must address:  Playground safety hazards  Playground supervision  Maintenance and general up keep of the outdoor area  Age and developmentally appropriate playground

equipment

 The number of staff required to complete safety training depends on the licensed capacity of the center.

Licensed Capacity # of Staff with Safety Training Less than 30 1

More than 30 2* *including the administrator

 Staff counted to meet this requirement must complete the training within six (6) months from the date of employment, or from the date a vacancy occurs.

 Once a staff member completes the safety training, they do not have to renew or take it again. Documentation of the safety training must remain on file at the center.

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 For licensed public school programs, staff are not required to complete this training.

CHILD CARE RULE .0705 ITS-SIDS Training for Staff

 In centers that are licensed to care for infants ages 12 months and younger, the center director and any child care provider scheduled to work in the infant room, including volunteers counted in staff-child ratio, must complete ITS-SIDS training.

 The training must be completed within 4 months of the individual assuming responsibilities in the infant room or as an administrator, and must complete again every 3 years from the completion of previous ITS-SIDS training.

 “ITS-SIDS training” means the Infant/Toddler Safe Sleep and

SIDS Risk Reduction Training developed by the NC Healthy Start Foundation for the Division of Child Development for caregivers of children ages 12 months and younger.

 As part of staff orientation, infant caregivers must be informed of the child care center’s safe sleep policy.

HH – Train staff prior to them being responsible for the care of infants to ensure they are aware that infants 12 months and younger should be placed on their backs to sleep.

 There are over 200 ITS-SIDS trainers across the state. There are several ways to locate a trainer in your area. You may visit the Division’s web site at www.ncchildcare.net for a list of current trainers, contact your local Child Care Resource and Referral agency or contact a local child care health consultant to find out about training opportunities in your area. To locate a Child Care Health Consultant in your area, visit the Child Care Health and Safety Resource Center’s web site at www.healthychildcarenc.org for a listing of child care health consultants by county or call the Resource Center at 1-800- 367-2229.

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SECTION 12: STAFF ORIENTATION REQUIREMENTS

CHILD CARE RULE .0707 Staff Orientation

 Each staff member who is expected to have contact with children must receive at least 16 clock hours of on-site training and orientation. Some topics must be covered within the first 2 weeks of employment and others within the first 6 weeks of employment.

 The training and orientation must include:  Within the first two weeks:

 Recognition of the signs and symptoms of child abuse or neglect and the employees duty to report suspected abuse and neglect

 The center’s operational policies, including the center’s safe sleep policy for infants (if center licensed to care for infants)

 Adequate supervision of children, taking into account their age, emotional, physical and cognitive development

 Within the first six weeks:  First-hand observation of the center’s purposes and

goals

 Instruction in the employee’s assigned duties  Instruction in the maintenance of a safe and healthy

environment

 Review of the center’s personnel policies  Review of the child care licensing law and rules  Explanation of the role of state and local government

agencies in the regulation of child care, their impact on the operation of the center, and their availability as a resource

 Explanation of the employee’s obligation to cooperate with representatives of state and local government agencies during visits and investigations

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CHILD CARE RULE .0709 Documentation of Staff Orientation

 The center must have a record of each staff member’s participation in training activities.  Documentation of on-site training and orientation must be on file for each staff member.

 The record of training must include: 1. The subject matter 2. Topic area (G.S. 110-91(11) 3. Name of person providing training 4. Date provided 5. Number of hours of training received 6. Name of staff member who completed training 7. Orientation training that is not related to direct caregiving

must be provided at a time when the new staff member is NOT counted as part of the staff-child ratio.

8. Prelicensing visits with a child care consultant may be documented towards orientation hours as long as the visit consisted of a review of the child care licensing law and rules.

 Orientation hours do not transfer if a staff member moves to another center unless the new center is owned by the same franchise or operator as the one where the staff member previously worked.

 Orientation hours do not count as part of the individuals required in-service training hours.

 A copy of the Documentation of Staff Orientation form is located in the resource section.

SECTION 13: IN-SERVICE TRAINING REQUIREMENTS

In-service training is training that is received during a staff member’s employment. It is considered on-going staff development, appropriate to job responsibilities, and is intended to

expand on previous learning and may enhance the educational levels of the staff members.

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NC GENERAL STATUTE 110-91(11) Approved Topic Areas for In-Service Training

 Training must be in the following topic areas:  Planning a safe, healthy learning environment;  Steps to advance children’s physical and intellectual development;  Positive ways to support children’s social and emotional development;  Strategies to establish productive relationships with families;  Strategies to manage an effective program operation;  Maintaining a commitment to professionalism;  Observing and recording children’s behavior;  Principles of child growth and development; and  Learning activities that promote inclusion of children with special needs.

 Only training in the above listed topic areas may be used toward meeting annual in-service training requirements for a staff member in a child care center.

 Training does not have to be formal semester hours. In-service training credit can be received by attending conferences and workshops as long as the training is approved by the Division.

 College coursework in any of these topic areas that results in earned semester credit hours may be counted for in-service training hours. The same semester credit hours may also be counted to enhance the education level of the individual.

CHILD CARE RULE .0707 In-Service Training for Staff

 All staff that have responsibility for planning and supervising a child care program, as well as staff who work directly with children, must participate in in-service training activities annually.

 The number of clock hours of yearly training required is based on the education and/or experience of each individual person.

 For full-time employees, the requirements are as follows:

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Level of Education Experience In-service training required

Four year degree or higher advanced degree in a child care related field of study

Two year degree in a child care related field of study or NCECAC/equivalent

Certificate or diploma in a child care related field of study or NCECC/equivalent

10 years documented experience as a teacher, director, or caregiver in a licensed child care facility

None of the above

None of the above 20

 All above in-service training hour requirements are actual clock hours of training that must be received annually.

 If a child care administrator or lead teacher is currently enrolled in coursework to meet staff qualifications, completed coursework may be counted toward meeting the annual in- service training requirement.

 For staff members working less than 40 hours per week on a regular basis, who are at the level of education/experience that requires 20 hours of in-service training, the training requirements may be pro-rated as follows:

Total working hours per week

Annual clock hours required

0 - 10 5 11 – 20 10 21 – 30 15 31 – 40 20

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 All degrees and coursework must be in a child care related field of study which is defined as Child Development, Child Psychology, Early Childhood Education, or Human Development from an accredited college or university. Other fields of study related to the care of young children must be approved by the Child Care Workforce Standards Section of the Division.

 If a staff member is required to receive less than 20 hours of in- service training per year, they may not count the hours received by taking a CPR certification course.

 Training hours received from taking a first aid course may be counted by any staff member, but no more frequently than once every three years.

 If a staff member receives more than the required number of hours in a given year, they may carry forward into the next year no more than one-half of the number of hours needed for the new year.

 All staff members that have responsibility for planning and supervising a public school program, as well as staff members who work directly with children, must participate in annual in- service training requirements.

 In-service training required of pubic school system employees can be used to meet this requirement as long as the training pertains to the topics contained in the child care law and meets the proper number of in-service training/contact hours of credit.

 Documentation of in-serving training for public school staff must be kept on-site at the licensed public school program.

 When the public school staff member attends a training event, whether sponsored by the school system or not, they should receive written verification of their attendance. This verification must include the name of the trainer, date, contact hours present, and the topic of the training. The staff member can maintain the original verification of this training as long as a copy is placed with his/her on-site record of in-service training.

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Can you give an example of how to properly calculate excess training hours that are carried over to another training year? A staff member is required to receive 20 hours of in-service training per year. During one year, they complete 45 hours of training. The 20 hours required for the current year are subtracted which leaves 25 remaining hours. The next years requirement is hours, and they may carry forward ½ of that requirement from the previous year. This employee may carry over 10 hours to the new year and then have to complete a minimum of 10 additional hours of training.

CHILD CARE RULE .0709 Documentation of In-Service Training for Staff

 The center must have a record of each staff member’s participation in training activities.  Documentation must be on file and current for each staff member.

 The record of training must include: 1. The subject matter 2. Topic area (G.S. 110-91(11)) 3. Name of person providing training 4. Date provided 5. Number of hours of training received 6. Name of staff member who completed training

 Training certificates received as documentation of training must be attached to the staff member’s individual training record.

 A Record of In-Service Training form is located in the resource section.

SECTION 14: TRAINING APPROVAL

All training offered to meet in-service training requirements must satisfy criteria for approval from the Division.

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CHILD CARE RULE .0708 In-Service Training Approval Process

Staff may meet in-service training requirements by attending child care workshops, seminars, or courses, provided each training activity satisfies the following criteria:

 Prior approval from the Division is not required for training offered by a college or university with nationally recognized regional accreditation, a government agency, or a state or national professional organization or its affiliates.

 Prior approval from the Division is required for any agencies, organizations, or individuals who wish to provide training for child care operators and staff. To obtain such approval, the agency, organization, or individual must complete and submit the in-service training approval forms provided by the Division at least 20 business days prior to the training event. A training roster listing the attendee’s name, the county of employment, and day time phone number must be submitted to the Division no later than 15 days after the training event. The event sponsor must provide training evaluations to be completed by attendees and must keep the evaluations on file for three years.

 Prior approval will be determined based on:  The trainer’s education, training, and experience relevant to the training topic;  Best practice in adult learning principles;  Content that is in compliance with General Statute 110-91(11); and  Contact hours reasonable for the proposed topic.

 Government agencies or state or national professional organizations who provide training must submit an annual training plan on a form provided by the Division for review by the Division. An annual plan is not required for any state, national, or international conferences sponsored by a professional child care organization.

 Distance learning such as internet based or correspondence courses must have prior approval from the Division in order to be counted for in-service training hours.

 Curriculum coursework or continuing education coursework that relates to the nine topic areas in the child care law through a post-secondary institution with nationally recognized regional accreditation may be used for in-service training hours without prior approval.

 One semester credit hour is equal to 16 clock hours. Coursework content must relate to one of the nine topic areas in the child care law and also be relative to the staff member’s job responsibilities in the child care facility.

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 Before attending a training session or hiring a trainer, you can call the Division and request to speak with the in-service training coordinator to determine if the training has been approved.

 The Division of Child Development does not maintain copies of specific training certificates. If an individual loses their training certificate, they would need to contact the individual training instructor or the sponsor of the training session.

 Staff are encouraged to maintain their own professional development file at home that contains proof of all their training sessions and certifications.

 Refer to the resource section to read In-Service Training Frequently Asked Questions (FAQs).

 In-service training approval request forms are located on the Division’s website at www.ncchildcare.net.

SECTION 15: REPORTING SUSPECTED ABUSE AND NEGLECT

NC GENERAL STATUTE 7B-301 Reporting Suspected Child Abuse and Neglect

 Any child care operator or staff member who suspects a child has been abused or neglected must notify the proper authorities. This requirement applies regardless of where the abuse may have occurred, be it at the child's home or the child care center.

 NC law requires any person who has reason to suspect child abuse or neglect to report the case to the local county Department of Social Services (DSS). In addition to calling DSS, any person may call the Division of Child Development at (919)662-4499 or (800)859-0829 to make a report of suspected child abuse or neglect in a child care program.

 Reports may be made anonymously. A person cannot be held liable for a report made in good faith.

 If the abuse or neglect is suspected to have occurred at a child care center, the Division of Child Development will initiate an investigation along with the local Department of Social Services.

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http://www.dhhs.state.nc.us/dss/local/index.htm

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 Check with the operator of your child care center for their policies on filing reports. The operator can assist you with finding the correct agency to file the report. In some situations, they can even make the report for you. But remember, if you express your concerns to the center operator and they choose not to file a report, you must do so yourself.

 Information regarding the signs and symptoms of child abuse and neglect must be a part of an employee’s orientation. This training should also cover the center’s policies on reporting child abuse and neglect.

 The address and phone number of your local DSS can be found in the front of your local phone book in the county government section or through the NC DSS county directory at www.dhhs.state.nc.us/dss/local/index.htm.

 For more information on recognizing and reporting child abuse visit Prevent Child Abuse North Carolina at www.preventchildabusenc.org.

 A complete copy of NC General Statute 7B-301(1999) the Mandatory Reporting Law is located in the resource section.

http://www.preventchildabusenc.org/

Division of Child Development Child Care Handbook

Resource Section

Chapter 2: STAFF

The following pages contain resource materials discussed in or

Updated 8.09

STAFF FILE CHECKLIST

Name of Employee: _______________________________ Date of Employment: ____________

The following items must be present in each staff member’s personnel file, except for items marked (*) which are only required for centers meeting voluntary enhanced standards.

Item Due Date Date Received/ Completed

 Employment Application Day One  Initial Medical Report Within 60 days of Employment  TB Test Results Day One  Annual Health Questionnaire Day 1 and Annually  Emergency Information on Staff Day One  CRC Qualification Letter or copies of submitted documents 1

st 5 Days & Every 3 years

 Documentation of Orientation 1 st 2 weeks/ 6 weeks of Employment

 Documentation of In-service Training Annually  Documentation of CPR/First Aid Certification (if applicable) Day One  Documentation of Playground Safety Training (if applicable) Within 6 months of Employment  Documentation of BSAC training (if applicable) Within 3 months of Employment  Documentation of ITS-SIDS Safe Sleep Training (if applicable) Within 4 months of Employment & every

3 years

 Credential Verification or Education Equivalency Information Must begin by 6 th

month of Employment

 Annual Staff Development Plan and Evaluations* Annually  Documentation of Job Description Receipt* When Applicable  Documentation of Operational and Personnel Policy Receipt* When Applicable  Documentation of Aquatic Activities Policy Receipt Day 1 & Annually  

What is the difference between EEC and individual licensure? EEC is acknowledgement of an individual’s verified level of educational achievement, based on a standardized scale. EEC does not issue a personal or teacher license.

How much does it cost? EEC is a self-supporting system, which has been created with funding from private and public sources with a goal of being funded primarily by individual fees when fully implemented. EEC fees are aligned with charges required by similar NC professions. The cost for an initial review is $50. The fee for EEC recertification is $25, if completed prior to the issued expiration date. In some cases, support for application fees may be provided by local agency grants, professional associations, an employer or other sources.

What is the EEC application process?

Step 1: Complete and sign your application.

Step 2: Attach all official transcripts (for degrees and individual courses) to your application.

Step 3: Attach a check or money order.

Step 4: Make a copy of all materials for your files.

Step 5: Mail to: NC Institute for Early Childhood Professional Development, PO Box 959, Chapel Hill, NC 27514

Does my EEC expire? Your certificate is valid for a period of time based on the amount of education you possess when you become certified. The period ranges from 2 to 5 years dependent on your education level. If you obtain more education in between recertification periods you may choose to submit your official transcripts to the Institute to increase your EEC level.

Why am I required to continue my education? As with all professions, certified individuals must continue their education to maintain their professional certification.

For level 5 and below (silver levels), EEC professionals must continue their education at a rate of 6 semester credit hours per certification period. Coursework in any field will be accepted toward the 6 semester hours required for recertification at any level. Early Educators are encouraged to take coursework that will help them achieve a higher EEC level. For levels 6 and above (gold levels), EEC professionals must complete 6 semester credit hours or 10 continuing education units (CEU) or a combination of the two. For either level 9 or 10, professionals who are certified and who teach in a higher education system may receive credit for teaching rather than having to complete formal coursework.

Can I apply if I am not currently employed in North Carolina? All persons who are currently or considering working directly with or on the behalf of children ages birth to twelve are eligible to become certified as a NC Early Educator by submitting the required paperwork. Out-of-state applicants may apply for EEC with the submission of the required paperwork.

What resources are available to help me pay for early childhood college courses and plan my career?

T.E.A.C.H. Early Childhood® Scholarships (www.childcareservices.org/ps/teach.html) Institute career and education planning tools (www.ncchildcare.org)

The Next Step in Professionalizing

the Field

North Carolina Institute for Early Childhood Professional Development

PO Box 959, Chapel Hill, North Carolina 27514 EEC Department – [email protected] or 919-942-7442

Institute Coordinator – [email protected]

Early Educator Certification (EEC)

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DCD Child Care Handbook Chapter 2 Resource 2

http://www.childcareservices.org/ps/teach.html

http://www.ncchildcare.org

mailto:[email protected]

Why should I get certified? As with other occupations, EEC recognizes and validates educational accomplishments of Early Educators. Individuals, families, children, programs and society benefit when the education of those working in a profession increases.

Individuals benefit! EEC increases professional recognition for individuals and serves to professionalize our field. EEC may lead to higher wages through salary supplement programs. EEC may lead to discounts from retailers and vendors. EEC provides portable evidence of professional development for use when applying for college, seeking employment and demonstrating knowledge and skill set to others. EEC encourages and empowers individuals to be professionals – planning, pursuing and documenting their own professional development activities on an ongoing basis.

Children benefit! Research has shown that the higher the education of the teacher, the better the outcome for children. When teachers have more college education....

Children are served in higher quality settings.1

Children are served in developmentally appropriate settings.2

Children are less likely to be abused and neglected.3

Programs benefit! A centralized EEC data system reduces administrative workload. EEC provides a workforce recruitment tool for new hires. Supporting EEC provides a retention strategy for current staff. EEC provides encouragement for staff to achieve higher levels of education.

1 North Carolina Rated License Assessment Project (http://ncrlap.uncg.edu) 2 North Carolina Rated License Assessment Project (http://ncrlap.uncg.edu) 3 North Carolina Abuse & Neglect Statistics 2001-02 and 2002-03 provided by Child Care Services

Association, Chapel Hill, NC

We are professionals. Teachers and teacher assistants working in child care, pre-kindergarten and Head Start settings, school age group leaders and coordinators, family child care providers, administrators, faculty, specialists, coordinators, trainers, consultants and researchers and more compose a growing workforce of professional Early Educators in North Carolina. Our profession is based on research and guided by standards for practice that together serve to inform the services we provide to children and families.

Are you ready to be part of a profession? North Carolina is the first in the nation to increase its workforce professional development standards by certifying the education of those who work directly with, intend to work with, and/or work on the behalf of children ages birth to twelve.

How have other occupations become professions? School teachers have it, nurses have it, hair dressers have it, even plumbers have it! Almost all occupations in the United States require their workforce to become certified to be part of the profession. It’s time for our field to be recognized as a profession with a specialized body of knowledge and defined skills required of each position.

What organization certifies Early Educators in North Carolina? The NC Institute for Early Childhood Professional Development (Institute), founded in 1993, is the certifying body for Early Educators in North Carolina.

The mission of the Institute is to define and advocate for the implementation of a comprehensive early childhood professional development system that provides supportive, accessible, and individually appropriate education which is linked to compensation in order to ensure high quality care and education services for children and families.

To learn more about the Institute go to:

www.ncchildcare.org

What is Early Educator Certification? EEC is acknowledgement of an individual’s verified level of educational achievement, based on a standardized scale. Education is the basis for EEC. Education is coursework taken at a regionally accredited college or university. All public community colleges and universities in North Carolina are regionally accredited.

What is an EEC level? An EEC level is a step on an Early Educator Scale that reflects the amount of education earned in the field of early childhood education (ECE), child development (CD) or related fields of study.

How do I qualify for EEC? To apply for EEC, submit an application, official college transcripts for ALL courses taken and/or degrees earned and the initial EEC fee to the Institute. Credit for professional work experience is not used to determine your EEC level.

Is a test required to be a certified Early Educator in North Carolina? No test is currently required to obtain EEC.

For a list of regionally accredited college and university programs go to:

http://www.chea.org/Directories/regional.asp

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DCD Child Care Handbook Chapter 2 Resource 2

http://www.chea.org/Directories/regional.asp

http://ncrlap.uncg.edu

http://www.ncchildcare.org

EEC Frequently Asked Questions

EEC03_FAQ updated 12/17/08

What is Early Educator Certification? EEC is acknowledgement of an individual’s verified level of educational achievement, based on a standardized scale. An EEC level will be assigned using the education documentation submitted and an existing scale. Information about the scale can be accessed through project staff.

Why should I get certified? As with other occupations, EEC recognizes and validates educational accomplishments of Early Educators. Individuals, children, programs, and society benefit when the education of those working in a profession increases. How have other occupations become professions? School teachers have it, nurses have it, hair dressers have it, even plumbers have it! Almost all occupations in the United States require their workforce to become certified to be part of the profession. It’s time for our field to be recognized as a profession with a specialized body of knowledge and defined skills required of each position. What organization certifies Early Educators in NC? The NC Institute for Early Childhood Professional Development (Institute), founded in 1993, is the certifying body for Early Educators in North Carolina. The mission of the Institute is to define and advocate for the implementation of a comprehensive early childhood professional development system that provides supportive, accessible, and individually appropriate education which is linked to compensation in order to ensure high quality care and education services for children and families. What is an EEC level? An EEC level is a step on an Early Educator Scale that reflects the amount of education earned in the field of early childhood education (ECE), child development (CD) or related fields of study. How do I qualify for EEC? If you work directly with or intend to work directly with children ages birth to twelve, you can apply for EEC. Submit an application, official college transcripts for ALL courses taken and/or degrees earned and the initial EEC fee to the Institute. Credit for professional work experience is not used to determine your EEC level. Important Note: EEC is open to a limited population at this time. If you are not currently working directly

with children ages birth to twelve, please continue to check the EEC website (www.nceec.org) for information on when you are eligible to apply.

Is a test required to be a certified Early Educator in NC? No test is currently required to obtain EEC. What is the difference between EEC and individual licensure? EEC is acknowledgement of an individual’s verified level of educational achievement, based on a standardized scale. EEC does not issue a personal or teacher license. For example, North Carolina Birth-through-Kindergarten licensure is granted under the authority of the North Carolina State Board of Education to individuals who successfully complete formal education and student teaching requirements through an accredited teacher education program.

How much does it cost? EEC is a self-supporting system, which has been created with funding from private and public sources and is now funded primarily by individual fees. EEC fees are aligned with charges required by similar NC professions. The cost for an initial review is $50. The fee for EEC recertification is $25, if completed prior to the issued expiration date. In some cases, support for application fees may be provided by local agency grants, professional associations, an employer or other sources.

To learn more about the Institute go to: www.ncchildcare.org

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DCD Child Care Handbook Chapter 2 Resource 3

http://www.ncchildcare.org

http://www.nceec.org

EEC Frequently Asked Questions

EEC03_FAQ updated 12/17/08

What is the EEC application process?

Step 1: Complete and sign your application. Step 2: Attach all official transcripts (for degrees and individual courses) to your application. Step 3: Attach a check or money order if fee is not covered by another source. (Questions? Email [email protected].) Step 4: Make a copy of all materials for your files. Step 5: Mail to: NC Institute for Early Childhood Professional Development, PO Box 959, Chapel Hill, NC 27514 What will I get when I am certified? A personalized EEC card for your wallet and an official certificate (with a gold or silver seal) ready for framing will be sent to you.

Does my EEC expire? Your certificate is valid for a period of time based on the amount of education you possess when you become certified. The period ranges from 2 to 5 years dependent on your education level. If you obtain more education in between recertification periods, you may choose to submit your official transcripts to the Institute to increase your EEC level.

Who is responsible for submitting education information? Individuals are responsible for submitting documentation of ongoing education. Am I required to continue my education? To maintain your EEC, you must continue your education following the guidelines below.

For level 5 and below (Silver Levels), EEC professionals must continue their education at a rate of 6 semester credit hours per certification period. Coursework in any field will be accepted toward the 6 semester hours required for recertification at any level. Early Educators are encouraged to take coursework that will help them achieve a higher EEC level. For level 6 and above (Gold Levels), EEC professionals must complete 6 semester credit hours or 10 continuing education units (CEU) or a combination of the two. For either level 9 or 10, professionals who are certified and who teach in a higher education system may receive credit for teaching rather than having to complete formal coursework.

Can I apply if I am not currently employed in North Carolina? All persons who are currently or considering working directly with or on the behalf of children ages birth to twelve are eligible to become certified as a NC Early Educator by submitting the required paperwork. Out-of-state applicants can apply for EEC with the submission of the required documents.

Is Certification required? The NC Institute for Early Childhood Professional Development does not have regulatory authority to require certification. Certification is a voluntary process.

NC Institute for Early Childhood Professional Development Early Educator Certification (EEC) Department

PO Box 959 Chapel Hill, NC 27514 [email protected] or 919-942-7442

mmckinzie

Typewritten Text

DCD Child Care Handbook Chapter 2 Resource 3

mailto:[email protected]

SUGGESTIONS FOR PREVENTING CHILD ABUSE AND CHILD NEGLECT IN YOUR CHILD CARE FACILITY

GUIDELINES FOR ADMINISTRATORS AND BOARDS 1. Screen applicants with thorough reference checks, including talking with last employer.

2. Develop clear guidelines on behavior management. Written discipline policies and procedures should

be given to each employee and parent.

3. Immediately report any observations or incidents of suspected child abuse or child neglect- for legal,

ethical and self-protection reasons.

4. Provide some opportunities for caregivers to have some relief- breaks, relief caregivers, etc.

5. Maintain manageable group sizes.

6. Have clear substitute policies and an up-to-date list of well-trained substitutes.

7. Don’t hesitate to talk to parents of children who are disruptive and to insist on professional help when

it is needed.

8. Make provisions for regular inservice training.

9. Evaluate staff often. Visit classrooms frequently.

10. Don’t hesitate to terminate an employee who has overstepped reasonable discipline practices.

11. Insure through adequate staffing and policies that no child is ever out of sight of a caregiver.

12. Make sure caregivers have adequate knowledge of child development so that children’s

social/emotional and physical needs are met.

13. When appropriate, report complaints you have received concerning other caregivers (to DSS or DCD).

14. Hire all new staff for a probationary period.

15. Develop procedures for recording all injuries or accidents involving children. Include the date, time of

incident, description of incident, and any action taken by staff. Also record any unusual marks or

bruises that a child has upon arrival so that they can not be attributed to the program.

Pointers for Reducing the Likelihood of Incidents of Child Abuse or Neglect in Child Care Settings

Many of the incidents investigated by local departments of social services and Division of Child Development Child Abuse/Neglect Consultants in child care programs could be prevented by close attention to certain key factors. The information which follows is offered in the hope that child care directors, family child care home providers, center owners, ministers of education, chairs of child care boards, teachers, and caregivers, etc. will find it helpful in maintaining safe programs! The key factors which will be discussed in the sections that follow include: Supervision Improve the quality of supervision in the classroom, on the playground, on field trips, while transporting to and from the program, in the bathroom, and at naptime. Safety Pay close attention to safety, including while transporting, on the playground, and in the classroom. Response to Injuries, Accidents, and Illnesses Handle injuries, accidents, and illnesses appropriately. This includes response, treatment, investigation, documentation, and reporting. Behavior Management Manage the behavior of children in positive ways. This includes educating staff in positive techniques as well as in staff behavior which cannot be tolerated. Documentation Document significant incidents and train staff to do the same: who?, what?, where?, when?, why?, and how? Sexual Abuse Protect staff against allegations of child sexual abuse with good management. Policies and Procedures Develop needed policies and procedures in writing, including health, medicine, transportation, field trips, personnel, discipline and guidance, abuse/neglect, parent involvement and communication. Train and Re-train Staff Train and review regularly with staff: child development, age-appropriate expectations, guidance, activities, schedules, transitions, safety, First Aid, emergency response, supervision, and mandatory reporting. Special Considerations For Infants, Toddlers, and Children With Special Needs The care of very young and special needs children requires extra diligence.

Improve the Quality of Supervision......... Playground  Circulate - don’t sit or stand in an area away from the main action of the playground.  Stay close to high risk areas such as climbers, slides, and swings. Prevent unsafe, risky behavior by

being close enough to the children to be aware of it immediately.  Don’t socialize with other adults while responsible for children.  Insist that children use equipment safely. With older children, use group times occasionally for

lessons on playground safety. Be consistent in enforcing playground safety rules with children.  Monitor doors and gates. Gates should latch securely and fences should not have gaps which children

can climb under.  Don’t allow parents to pick children up from the playground if it is center policy not to allow that.  Don’t allow children to go back inside the building alone. If one teacher is outside alone with her

group and a child in the group needs to be back inside to use the bathroom, have a cooperative arrangement with a teacher or other staff member so that person can be requested to take responsibility for the child.

 Don’t leave any children outside when you go inside. Don’t allow children to get out of sight while they are on the playground. Take attendance by name when you go back inside. If the playground has any blind spots, a plan needs to be developed to supervise these areas properly.

 Scan the playground. That is, be aware of the entire scene! If several teachers are outside at the same time, develop a cooperative plan so that at least one of the teachers is always providing an overview of the entire playground scene.

Nap Room  Position the children so that each one can be seen by a teacher.  Don’t allow a child to leave the classroom alone to use the bathroom.  Don’t leave the classroom unattended at naptime. Classroom  Don’t allow a child or children to leave the classroom unattended for any reason (bathroom, visit next

door, run errands, run out to greet parent, etc.)  Train teachers in the habit of routinely scanning the classroom as a whole to be aware of any problems

developing. If two or more teachers work together in the same room, encourage a cooperative approach to this responsibility.

 Arrange activity centers and furniture in the room to prevent areas which cannot be easily supervised.  Provide training regularly for caregivers to never leave infants or babies unattended on changing

tables. Locate supplies at the changing area.  Position the changing table so that the caregiver is able to see the activity going on in the room. If a

caregiver has a particular child who is likely to bite or hurt another child when she is changing a diaper and respond immediately, develop a protection plan for this situation.

 Train caregivers to provide very close supervision to infants and toddlers of different ages when they are together.

Bathroom  Don’t allow children to use the bathroom unsupervised.  If the children’s bathroom is not in the classroom but is located down the hall, do not allow a child to

leave the classroom unattended. A supervision plan needs to be developed for this situation.

Improve the Quality of Supervision....cont. Field Trips and Transportation  Each teacher should have an accurate, clearly readable attendance roster, which has first name and last

name of each child. No child should be listed on more than one roster.  Take attendance by name and face at key times on field trips, using the roster, including:  before leaving the child care facility  upon arrival at the field trip site  after entering the field trip site  occasionally during the site visit  before departure from the field trip site  upon arrival back at the child care facility  upon reentering the classroom  Count heads occasionally in addition to taking attendance...but counting heads is no substitute for

taking attendance by name and face recognition.  Do a physical check of the entire vehicle after all of the children have exited, to be absolutely certain

that no child has fallen sleep or been left behind.  Don’t allow children to leave the group, stray to another room, or go to the bathroom unattended

during the field trip.  If you place identification on the child, have it be the name of the program, not the name of the child.  Have additional adults to assist on the trip. Don’t try to do a field trip with the ratio of children to

adults that is permissible in the classroom.  Clarify the responsibilities of all of the adults on the trip.  Involve the children in the safety of the trip by meeting as a group before and reviewing field trip

safety rules.  Be familiar with the field trip site before visiting it. In this way, potential problems with supervision

can be planned for.  Develop an emergency plan in the event a child does become separated from the group.  Develop written job descriptions for all staff members responsible for transportation and review these

with them before they assume those responsibilities and at frequent intervals afterwards. Home Transportation  For programs providing transportation to and from home, it is essential to have clearly developed

guidelines for staff and parents in regards to the safe pick-up and delivery of children, so that children are not turned over to unauthorized persons, or worse, left unattended in their neighborhood.

 Staff should have an accurate attendance roster, just as for field trip transportation. Doing a physical check of the vehicle at the end of the trip is absolutely essential.

Pay Close Attention To Safety.... Transportation  Use age-appropriate child restraint devices (car seats) properly installed. North Carolina state law

requires child restraint device for children up to age 8 or 80 pounds.  Use individual seat belts, properly fastened. Don’t fasten more than one child in one belt.  Maintain the vehicle properly: brake, tires, annual inspection, etc.  Carry emergency information for all persons being transported, including authorization to seek

emergency medical care for children. Making photocopies of original applications is one way to do this.

 Don’t overload the van or allow anyone to ride in the cargo area. Playground  Maintain safe equipment: no sharp points, broken parts, unanchored poles, equipment that is too high,

too steep, inherently dangerous, etc...  Provide resilient surfaces to protect when falls occur. This may be sand, mulch, mats, pine bark, etc.

Don’t allow children to use the play equipment inappropriately. Enforce the rules.  Involve the children in playground safety. Teach them playground safety rules.  Have equipment that is age-appropriate and separate ages on the playground.  Provide training for all staff in playground safety. Review regularly at staff meetings. Classroom  Have equipment that is safe and properly maintained.  Pay attention to doors and gates that could pinch or trap a finger.  Remove broken toys and equipment promptly.  Maintain a safe environment  no extension cords  no electrical cords within reach  no unplugged electrical outlets  no small parts in infant-toddler-2’s rooms  no exposed screws  no unlocked medications or cleaning supplies  no venetian blind cords within reach of cribs  no exposed foam or loose fabric  Equip diaper-change tables with ledges and safety straps  Don’t use microwaves to heat infant food. Microwaves may heat very unevenly and cause burns.  Don't use walkers for infants who don’t have the cognitive skills or coordination to manage the speed

their gross motor skills may enable them to achieve.  Place infants on their backs for sleep, rather than on their stomachs.  Monitor sleeping infants frequently.  NOTE: A very safe environment is no substitute for proper supervision. A safe environment

makes the job of supervision easier.

Respond Appropriately To Injuries, Accidents, and Illnesses  Have a current, immediately accessible Emergency Care Plan.  Activate the Emergency Care Plan when necessary.  Be certain all staff members are trained in this plan and review it with staff regularly.  There should always be someone present in the center who is designated to be in charge.  Maintain correct current contact information for parents at all times.  Call the parent as soon as possible after an injury or accident. Call after any blow, to the face, head,

eyes, nose, mouth, or ears, even if injury is not immediately apparent. Don’t diagnose. Staff members do not have the training to determine that a blow to the head is not a concussion or fracture.

 Write a complete, accurate injury report as soon as possible and make sure that the parent receives a

copy.  Place a copy in the child’s file and maintain an administrative copy.  If more than one person has been involved in an incident and/or the care provided afterwards, have

each teacher prepare a written report. Have the persons involved complete these reports, even if they need assistance with spelling or grammar. It needs to be a first hand report, not a second hand report written by another person.

 Determine the cause of an accident or injury and make any necessary changes in staffing, policies, etc.  Be aware that child care rules require that one or more staff persons be present during all operating

hours of the center who has completed first aid training within the last three years and CPR within the last year.

 Develop a proactive plan, in rooms for children who are toddlers or 2s in which biting is occurring,

that focuses on prevention and includes incident reports for parents of children affected.  Follow child care rules for medications completely. Don’t give medication about which you have any

doubts. It is always permissible to be more strict than the state rules allow - but not less strict.

Application for Employment (Fully complete both pages)

__________________Date of Application Please Print Social Security Number

Last Name First Name Middle Name

Address (street number and name)

City County

State Zip Code Phone (home or where you can be reached) Business Phone

Position Applied For:

Date of Birth: / / N. C. Driver’s License Number (month) (day) (year)

Have you ever been convicted of breaking a law other than a minor traffic violation? YES NO If yes, give the date and explain fully on an additional piece of paper if more space is needed Have you ever had a Department of Social Services (DSS) substantiation?

YES NO If yes, list county/State and give the date and explain fully on an additional piece of paper if more space is needed

REV 6.09

(The offense(s) and how recently you were convicted will be evaluated in relation to the job for which you are applying.)

Education

Circle the highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4

Schools Name and Location Dates Attended Coursed of Study Degree/Diploma

High School

College or to

University to

Graduate or to

Professional to

Educational, to

Vocational to

Schools, etc. to

Child care training you have completed in the last three years (such as first aid, CPR, CDA, ITS-SIDS, etc.):

DCD Childcare Handbook Chapter 2 Resource 6

References List the names, addresses and phone numbers of two people we may contact as references:

_____________________________________________________________________________________ __________________________________________________________________

Work History (List child care/early childhood experience first.)

Current or Last Employer

Address

Job Title

Supervisor’s Name No. Supervised by you

Date Employed (mo/yr)

Starting Salary $ Per

Ending Salary $ Per

Reason for leaving May we contact employer? yes no

Date Separated (mo/yr)

Duties:

Full Time

Years Months

Part Time

Years Months

If part time, number of hours per week

Current or Last Employer

Address

Job Title

Supervisor’s Name No. Supervised by you

Date Employed (mo/yr)

Starting Salary $ Per

Ending Salary $ Per

Reason for leaving May we contact employer? yes no

Date Separated (mo/yr)

Duties:

Full Time

Years Months

Part Time

Years Months

If part time, number of hours per week

I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration, and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications. Signature of Applicant Date ___________

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North Carolina Division of Social Services Request for Information from the Responsible Individuals List

IMPORTANT INFORMATION AND INSTRUCTIONS FOR COMPLETING DSS-5268 (please read carefully): Do NOT alter this form. Do NOT print on front and back of this form. NCGS § 7B-311 Authorizes the release of information regarding substantiated cases of abuse and serious neglect from the Responsible Individuals List (RIL), for the sole purpose of determining current or prospective employment in certain situations, or fitness to provide care for children. This includes applications to foster or adopt a child. DSS-5268 is the form used to request information from the Responsible Individuals List. All forms must be MAILED to: North Carolina Division of Social Services, Regulatory and Licensing Services, 952 Old US Highway 70, Black Mountain, North Carolina 28711, Attn: RIL Agencies may request RIL information to be returned as follows: Check ONE

MAIL – Submit one original AND one copy of DSS-5268 along with a self-addressed, stamped envelope. FAX – Submit DSS-5268 AND a completed fax cover sheet. (If submitting more than 5 requests at once, faxing is not an option)

All sections of Form DSS-5268 must be completed and signed by the agency and the prospective employee/volunteer. Please print legibly or type all information. Please do not staple. Incomplete forms will be returned via fax without the Responsible Individuals List check completed. The agency must then resubmit the corrected form via MAIL. Section I: Information regarding agency requesting a background check from the Responsible Individuals List Agency Name: _________________________________________________________________________ Mailing Address: ________________________________________________________________________ City: ______________________________ State: ___________________________ Zip: ______________ Phone: _____________________________________ Fax: _____________________________________ Email Address: _________________________________________________________________________ Type of Agency: Child Care Provider Child Caring Institution Child Placing Agency County DSS Group Home Facility Guardian ad Litem Other Provider of Adoption Other Provider of Foster Care Agency License Number: ______________________ Check if agency is licensed, but has no license # Section II: Agency Certification I hereby request information from the North Carolina Responsible Individuals List. I certify that I am a person representing a child caring institution, child placing agency, group home facility, or a provider of foster care, child care or adoption services that needs to determine the fitness of individuals to care for or adopt children. I either currently employ the individual listed below, or am strongly considering the individual for an employment, contract, or volunteer position. I will only use the information requested to determine whether to hire or retain the individual. Name and Title (print): ___________________________________________________________________ Signature: _____________________________________________________________________________ Date: ____________________________________

DSS-5268 (rev. 04/09) Child Welfare Services

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DSS-5268 (rev. 04/09) Child Welfare Services

Section III: Information regarding Employee (E), Applicant (A), or Volunteer (V) E, A or V’s Full Name (including MI): _______________________________________________________ E, A or V’s Date of Birth (MM/DD/CCYY): __________ / __________ / ____________________ E, A, or V’s Social Security Number (last four digits only): ____________________ E, A or V’s Gender: Male Female Other names E, A or V has used (maiden name, nicknames, former married names, etc.): __________ _____________________________________________________________________________________ Section IV: Employee, Applicant, or Volunteer Acknowledgement I acknowledge that I have been informed that the North Carolina Division of Social Services will disclose to the above named agency whether my name appears on the Responsible Individuals List, indicating that I am the subject of an existing substantiated report of child abuse or serious neglect. Name (print): __________________________________________________________________________ Signature: _____________________________________________________________________________ Date: ___________________________________ Section V: North Carolina Division of Social Services Office Use Only Initials

_______ Form submitted incomplete and returned to the agency without the Responsible Individuals List check completed.

_______ As of ____________________, employee’s name NOT found on the Responsible

Individuals List. _______ As of ____________________, employee’s name found on the Responsible

Individuals List. Finding: _____________________________________________________________ Print Name: ______________________________________________________________________ Signature: _______________________________________________________________________ Date: _________________________________

DCD.0120 – Revised 8/01/09

North Carolina Division of Child Development Workforce Change of Information Form (DCD.0120)

DCD Use Only WFID#

Complete and submit this form to the Workforce Education Unit when you have a change of information in name, address, facility of employment and/or educational status. You would also submit this form to request an education evaluation for a different child care position(s) after you had submitted an original Education and Equivalency Form. Please print or type.

SSN (Last 4 Digits Only): Email Address: Required Fields (Complete all fields in this section) Date of Birth (mm/dd/yy): Current Legal Name (First, Middle Initial, Last):

/ / Current Home Mailing Address: City: State: Zip Code:

Home Phone #: Cell Phone # (If Applicable): County of Residence:

( ) ( )

Date Current Name Effective: A. Change of Name (Complete this section if your legal name has changed) / /

Previous Legal Name (First, Middle Initial, Last):

Date Current Address Effective: B. Change of Address (Complete this section if your mailing address has changed) / / Previous Home Mailing Address: City: State: Zip Code:

Date Employed at this Facility: C. Change of Employment (Complete this section if your facility of employment has changed) / / Name of Current Facility: Facility ID # (on license): Facility Telephone #: ( ) Address of Current Facility: City: State: Zip Code:

Name of Previous Facility: Facility ID # (on license): Date Employment Ended:

/ /

D. Change of Educational Status (Check one or both options)

Attach all NEW college level official transcripts which have not been previously submitted to the Division of Child Development, Workforce Education Unit.

I have completed additional early childhood education college coursework since I last submitted an official transcript(s).

I have completed and been awarded a certificate, diploma and/or degree since I last submitted an official transcript(s).

E. Change of Child Care Position (Check one or multiple positions)

Attach all paperwork which is required to meet the education standards to qualify for the checked position(s).

Lead Teacher Teacher Family Child Care Home Provider Group Leader Program Coordinator

Note: If the change of child care position is for an Administrator, then you must submit an original NC Education and Equivalency Form for Child Care Administrators (DCD.0173) to be evaluated for qualification as an Administrator.

Mail to: NC Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions: Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

Comments:

NORTH CAROLINA EARLY CHILDHOOD ADMINISTRATION CREDENTIAL (NCECAC)

This credential is awarded at three levels and consists of three required components*:

1. Child Care Administration coursework (EDU 261 & 262 – five or six** semester credit hours in the North Carolina Community College System) Levels I, II, and III all have the same requirement in this component. o Child Care Administration I (EDU 261) – a survey course that focuses on basic

knowledge and skills needed to administer a child care program:  Program Framework  Rules and Regulations  Personnel  Financial Management

o Child Care Administration II (EDU 262) – a comprehensive course of study which includes advanced content on administration of a child care program:

 Resources for Centers and Families  Early Childhood Curriculum  Program Assessment  Advocacy and Leadership

** EDU 261 is being transitioned from a two semester hour course to three hours.

2. Early Childhood/Child Development coursework

 Level I: at least seven semester credit hours  Level II: Associate’s degree in the field  Level III: Bachelor’s degree in the field

3. Portfolio*** demonstrating administrative competencies

 Level I: completion of six portfolio assignments  Level II: completion of twelve portfolio assignments  Level III: completion of eighteen portfolio assignments

***a packet of specified assignments completed in EDU 261 & 262

* Each required component of the credential has one or more equivalency options. These are outlined on the attached grid (Instructions for North Carolina Child Care Administrators adapted from the application form that child care administrators of licensed facilities must submit to the NC Division of Child Development). Meeting any or all of the three components through the equivalency options will result in an administration equivalency instead of the credential. The North Carolina Child Care Administration Credential and Equivalency (Levels I, II and III) have equal weight in North Carolina’s tiered Star Rated License System.

Child Care Administrator Requirements October 2007 North Carolina Department of Health and Human Services, Division of Child Development

INSTRUCTIONS for North Carolina Child Care Administrators (adapted from application: NC Child Care Education & Equivalency Form)

Choose the highest level that describes your current status. Under that level, check a box in each of the three required components to show how you meet it. To be eligible for the NC Early Childhood Administration Credential certificate, you must complete the requirements in the  boxes in the level that you have chosen. If you have met requirements by checking any of the non-star boxes in the level that you have chosen, you are eligible for an equivalency letter only. Completion of the NC School-Age Child Care Administrator requirements results in an equivalency letter; there is no certificate.

Child Care Administrators Only Three Required

Components Level I Options

(Mandatory) 

Level II Options (Voluntary)



Level III Options (Voluntary)



EDU 261 and EDU 262  or EDU 261 and EDU 262  or EDU 261 and EDU 262  or Test out or Test out or Test out or 6 sch in Child Care Administration or 6 sch in Child Care Administration or 6 sch in Child Care Administration or

1. Administration

Coursework plus

9 sch in Business Administration 9 sch in Business Administration 9 sch in Business Administration 7 sch in EC/CD  or AA/AAS degree in EC/CD  or BA/BS degree in EC/CD  or

AA/AAS degree in any major with 12 sch in EC/CD or

2. Early Childhood / Child Development

Coursework plus

Director for 3 yrs and NCECC or equivalent (attach explanation)

Currently enrolled in BA/BS, 60 sch completed with 12 sch in EC/CD

BA/BS degree in any major with 18 sch in EC/CD

Level I Portfolio of 6 specified assignments  or

Level II Portfolio of 12 specified assignments  or

Level III Portfolio of 18 specified assignments  or

3. Portfolio completed in

EDU 261/262 courses or independently

Level I Portfolio waived if Director for 5 years (attach detailed explanation)

Level II Portfolio waived if Director for 5 years (attach detailed explanation)

Level III Portfolio waived if Director for 5 years (attach detailed explanation)

School Age Administrators Only (applies to child care programs ONLY serving children age 5 and older) Three Required

Components Level I Options

(Mandatory) 

Level II Options (Voluntary)



Level III Options (Voluntary)



EDU 261 and EDU 262 or EDU 261 and EDU 262 or EDU 261 and EDU 262 or Test out or Test out or Test out or 6 sch in Child Care Administration or 6 sch in Child Care Administration or 6 sch in Child Care Administration or

1. Administration

Coursework plus

9 sch in Business Administration 9 sch in Business Administration 9 sch in Business Administration 7 sch in EE/HG&D or AA/AAS degree in EE/HG&D or BA/BS degree in EE/HG&D or 2. Elementary Ed/

Human Growth & Development Coursework

plus

Director for 3 yrs and NCECC or equivalent (attach explanation)

AA/AAS degree in any major with 12 sch in EE/HG&D

BA/BS degree in any major with 18 sch in EE/HG&D

Level I Portfolio of 6 specified assignments or

Level II Portfolio of 12 specified assignments or

Level III Portfolio of 18 specified assignments or

3. Portfolio completed in

EDU 261/262 courses or independently

Level I Portfolio waived if Director for 5 years (attach detailed explanation)

Level II Portfolio waived if Director for 5 years (attach detailed explanation)

Level III Portfolio waived if Director for 5 years (attach detailed explanation)

KEY TO ABBREVIATIONS & TERMS EDU 261: Early Childhood Admin course taught at NC Community Colleges EDU 262: Early Childhood Admin course taught at NC Community Colleges NCECC: North Carolina Early Childhood Credential NCECAC: North Carolina Early Childhood Administration Credential EC/CD: Early Childhood / Child Development EE/HG&D: Elementary Education / Human Growth and Development AA/AAS: Associate’s Degree BA/BS: Bachelor’s Degree MA/MS: Master’s Degree sch: semester credit hours Portfolio: a collection of activities that demonstrate administrative skill and competency. A packet of specified portfolio assignments is completed in EDU 261/262 or independently by an applicant. North Carolina Department of Health and Human Services, Division of Child Development Child Care Administrator Requirements October 2007

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NC DIVISION OF CHILD DEVELOPMENT Workforce Standards Section / Education Unit August 2009

GUIDELINES TO EDUCATION EVALUATIONS FOR CHILD CARE PROVIDERS

APPLICATION PROCESS AND REQUIRED DOCUMENTATION

APPLICATION Education and Equivalency (E&E) Forms

Education and Equivalency (E&E) forms are applications used to gather identifying information and to show your intent to be qualified for a specific child care position. There are two E&E forms for child care positions:

 Education and Equivalency Form for Child Care Providers – DCD.0169: Use for Family Child Care Home Providers, Teachers, Lead Teachers, Program Coordinators and Group Leaders

 Education and Equivalency Form for Child Care Administrators – DCD.0173: Use for Child Care and School-Age Administrators

There are two E&E forms for public school (DPI) preschool staff:

 Public School Preschool Staff Education Form for Teachers/Teacher Assistants – DCD.0171

 Public School Preschool Staff Education Form for Administrators – DCD.0172

There is one E&E form for articulation of approved high school coursework to community college:

 Lead Teacher Equivalency Form for Approved High School Coursework – DCD.0170

When submitting an E&E form:

 complete the entire application  attach all requested documentation  sign and date the application

Failure to do these things will delay the processing of your application and may affect your facility’s

rated license education points.

If you are currently working or planning to work in any of the above listed child care positions, you need to submit the appropriate E&E form as an application to be qualified educationally per NC child care regulations.

Only submit each of the above E&E forms ONCE when applying for a child care position.

When you need to update and/or change identifying information and you are not initially applying for a child care position (as listed above), submit the Workforce Change of Information Form (DCD.0120).

Page 2 of 3

NC DIVISION OF CHILD DEVELOPMENT Workforce Standards Section / Education Unit August 2009

DOCUMENTATION Official Transcripts and Other Education Paperwork

Official transcripts provide documentation of completed college level coursework, certificates, diplomas and/or degrees.

When do you submit an official transcript (OT)?

 You need to submit an OT with your initial application (E&E form) if you have completed any college level coursework, certificates, diplomas and/or degrees.

 You need to submit another OT only when additional college level coursework, certificates, diplomas and/or degrees have been completed since the last time you submitted an OT.

Only official transcripts will be accepted – we will not evaluate from photocopies, student or internet copies, grade reports or from copies of college certificates, diplomas or degrees. Transcripts must be from colleges with nationally recognized regional accreditation in order to be evaluated for coursework and degrees.

Which child care positions require other education paperwork?

 Group Leader – completion of Basic School Age Care (BSAC) training is required for qualification; submit a legible copy of the BSAC certificate.

 Program Coordinator – completion of Basic School Age Care (BSAC) training is required if you are qualified as either a Lead Teacher or Administrator and you are meeting the requirements for qualification through this option; submit a legible copy of the BSAC certificate.

 Lead Teacher – submit a copy of any current national certificate – CDA, CCP, Montessori (AMS or AMI) – if this is how you will meet the requirements for qualification.

 Administrator – to meet the requirements for the portfolio component: o A portfolio assessment form should be submitted from the community college where you took

EDU 261 and EDU 262, OR

o Independently complete and submit a portfolio to be graded, OR

o Submit documentation in resume form of at least five (5) years of experience as a child care director, co- or assistant director to waive the portfolio requirement.

How do you apply for a NC Child Care Credential?

 Submit the Credential Application for Early Childhood Credential (NCECC), Family Child Care Credential (NCFCCC) and School Age Child Care Credential (NCSACCC) – DCD.0168

 Completion of the following courses is required for each child care credential. You must submit an official transcript for evaluation:

o NCECC (EDU 111 and 112 OR EDU 119) – You will also qualify as a Lead Teacher, Teacher and Family Child Care Home Provider if approved for credential

o NCFCCC (EDU 111 and EDU 113 OR EDU 119 and EDU 113) – You will also qualify as a Family Child Care Home Provider if approved for credential

o NCSACCC (EDU 145 and EDU 235 OR EDU 145 and EDU 263) – You will also qualify as a Program Coordinator if approved for credential

Page 3 of 3

NC DIVISION OF CHILD DEVELOPMENT Workforce Standards Section / Education Unit August 2009

WORKFORCE CHANGE OF INFORMATION FORM (COI) Form

The Workforce Change of Information form (DCD.0120) needs to be submitted when any of the following events occur:

 Change in legal name

 Change in address

 Change in child care facility where you are employed

 Change in educational status (completed additional coursework and/or degrees)

 Need to apply for another child care position after submitting an E&E form for Child Care Providers – DCD.0169. Note: If you need to apply for Administrator qualification, you will need to submit the E&E form for Administrators (DCD.0173) and not a COI form.

**Please DO NOT use an E&E form to update these changes**

If you are submitting an E&E form, you do not need to submit a separate COI form to update identifying information, since any changes will be included on the E&E form.

ITIONAL TIPS

for submitting education documents to Workforce

ADDITIONAL TIPS for Submitting Education Documents to Workforce

Official transcripts may be opened before you send them to Workforce. We strongly recommend opening the official transcript and making a copy for your files before submitting it to Workforce. Review your official transcript before submitting it to verify all coursework and degrees earned at that college are recorded on the transcript. All applications (E&Es), official transcripts, education paperwork and COI forms for an individual go into ONE file in the Workforce Education Unit. It is not necessary to send duplicate transcripts and certificates when applying for more than one position or when applying for a new position if a current official transcript has already been submitted. All foreign transcripts and/or degrees must be evaluated by an international education evaluation service to determine how they compare to U.S. education standards. These services can be found through an internet search for international education evaluators. A copy of this evaluation should be submitted to Workforce. A translation from the original language to English is not sufficient. Helpful information and resources can be found on the Division of Child Development website www.ncchildcare.net under Providers / Professional Development / FAQs.

DCD Child Care Workforce Standards Section February 2009 1

CHILD CARE WORKFORCE EDUCATION EVALUATION: CRITERIA AND POLICY

North Carolina’s child care licensing system establishes education standards for the child care workforce. Staff in all child care positions must meet minimum education requirements. All staff have the potential to contribute to a higher star rating for their facility by completing post-secondary education (university, college, community college coursework) beyond the minimum requirements. Education evaluators in the Child Care Workforce Standards Section of the North Carolina Division of Child Development assess the education of individuals working in child care to determine their qualifications. They do this by reviewing transcripts and identifying applicable course credits, based on specific criteria. Here is a guide to these criteria: WHAT COUNTS AND WHAT DOESN’T?  Only post-secondary credit is counted in education evaluations. This credit must

appear on official transcripts from post-secondary schools that have received nationally recognized regional accreditation.

 Continuing education and inservice training hours are never counted in determining an individual’s education qualifications.

ACCREDITATION  The college awarding post-secondary credit (including schools offering distance

education such as on-line coursework) must be accredited by one of the following nationally recognized regional accreditation agencies:

o Middle States Association of Colleges and Schools o New England Association of Schools and Colleges o North Central Association of Colleges and Schools o Northwest Commission on Colleges and Universities o Southern Association of Colleges and Schools o Western Association of Schools and Colleges

 For higher education institutions outside of the United States, the recognized system of the specified country’s accreditation process will be accepted.

DCD Child Care Workforce Standards Section February 2009 2

GUIDELINES FOR TRANSCRIPT SUBMISSIONS  The transcript must be "official” with a raised seal or on distinctive paper and with the

registrar’s signature, as specified by the college. Photocopies, computer print-outs, unofficial student copies and grade reports are not accepted.

 The transcript does NOT need to arrive at DCD in a sealed envelope. However, if the

transcript does not look official or if the name of the college is not clearly noted on the transcript, it is helpful to include the original envelope from the college when sending the official transcript to DCD. Make sure the transcript you submit shows all of your coursework at that college.

 Individuals are encouraged to make a copy of the transcript for their own records

before sending the original to DCD.  Transcripts from foreign countries: Official foreign transcripts in English may be

submitted to DCD for evaluation. If the coursework cannot be determined to clearly compare with the United States semester system of credits and degrees awarded, DCD will send the applicant a request for an international education evaluation.*

Foreign transcripts in any language other than English will need to be assessed by an international education evaluation service* that will report the educational equivalencies of the courses and degrees shown on the transcript. (Literal translations into English are not acceptable.) The report from the international education evaluation service should be submitted to DCD in place of a transcript. Cost for this service is the responsibility of the individual requesting the evaluation. * An internet search for international education evaluators will provide multiple sources for this service.

DCD Child Care Workforce Standards Section February 2009 3

ACCEPTABLE DEGREES AND COURSEWORK  The following degrees** are accepted for lead teacher equivalency and for the Early

Childhood/Child Development (EC/CD) coursework component for administrators: o AA/AAS in Early Childhood/ Child Development; o BA/BS in Early Childhood/ Child Development/ Human Growth &

Development/ B-K Education/ Early Childhood Special Education

** The degree earned must be shown on an official transcript, including the major and the date the degree was awarded. Copies of diplomas are not accepted as verification of degree completion. For those who want to qualify as lead teachers but do NOT have one of the degrees listed or have no degree at all, the following criteria apply to coursework***: When reviewing transcripts for coursework to meet lead teacher equivalency and extra hours, evaluators look for courses that emphasize a developmental understanding of young children and developmentally appropriate educational approaches for the early years. This is why elementary education degrees and coursework often do not qualify for credit, and why such courses as Introduction to Education, Education in Society and Foundations of Education are also not given credit as EC/CD coursework. For the same reason, general education courses required for a degree are NOT counted. ***For child care administrators: the same criteria apply to evaluations of coursework to satisfy the EC/CD component and extra hours. If an individual has not achieved a certificate, diploma or post-secondary degree, the coursework must be no more than ten years old at the time they submit their first application (an Education and Equivalency Form for any position) in order to be counted.  Courses routinely counted as Early Childhood/Child Development include:

o most EDU courses in the NC Community College System except a group of vocational courses (EDU 175, 176, 178, 179, 240, 245, 250, 285)

o some ASL (American Sign Language) prefixes [limited to developmental language and communication skills]

o DDT 120 Teaching Developmental Disabled (in NC Community Colleges)

DCD Child Care Workforce Standards Section February 2009 4

o o courses with Kindergarten (K) in the name o o some Psychology courses, including General, Introduction, Child

Psychology and Child Development  Additional courses counted for School-Age positions include:

o o the same EDU prefixes in the NC Community College System that count for EC/CD except EDU 234 Infants, Toddlers and Twos

o o the same Psychology courses plus Child/Adolescent Psychology and Child/Adolescent Development

 Practicums, internships and student teaching experiences are never counted as

EC/CD courses, although they may have earned course credit toward a degree.

 Other courses may be considered for appropriateness, usually through review of course descriptions. If such coursework is deemed appropriate, credit will be given on a case by case basis.

NC DHHS Division of Child Development

CHILD CARE WORKFORCE EDUCATION EVALUATION: CRITERIA AND POLICY

North Carolina’s child care licensing system establishes education standards

for the child care workforce. Staff in all child care positions must meet minimum education requirements. All staff have the potential to contribute to a higher star rating for their facility by completing post-secondary education (university, college, community college coursework) beyond the minimum requirements.

Education evaluators in the Child Care Workforce Standards Section of the

North Carolina Division of Child Development assess the education of individuals working in child care to determine their qualifications. They do this by reviewing transcripts and identifying applicable course credits, based on specific criteria. The policy requirements based on these criteria are as follows:

WHAT COUNTS AND WHAT DOESN’T?

 Only post-secondary credit is counted in education evaluations. This credit must appear on official transcripts from post-secondary schools that have received nationally recognized regional accreditation.

 Continuing education and in-service training hours are never counted in determining an individual’s education qualifications.

ACCREDITATION

 The college awarding post-secondary credit (including schools offering distance education such as on-line coursework) must be accredited by one of the following nationally recognized regional accreditation agencies:

 For higher education institutions outside of the United States, the recognized system of the specified country’s accreditation process will be accepted.

DCD Child Care Workforce Standards Section August 2009

NC DHHS Division of Child Development

GUIDELINES FOR TRANSCRIPT SUBMISSIONS

 The transcript must be "official” with a raised seal or on distinctive paper and with the registrar’s signature, as specified by the college. Photocopies, computer print-outs, unofficial student copies and grade reports are not accepted.

 The transcript does NOT need to arrive at DCD in a sealed envelope. However, if the transcript does not look official or if the name of the college is not clearly noted on the transcript, it is helpful to include the original envelope from the college when sending the official transcript to DCD. Make sure the transcript you submit shows all of your coursework at that college.

 Individuals are encouraged to make a copy of the transcript for their own records before sending the original to DCD.

 Please do not write or use highlighter on the official transcript that you send to DCD. The one exception is to write your current name next to the name shown on the official transcript if it has changed since you were enrolled.

 Transcripts from foreign countries: Official foreign transcripts in English may be submitted to DCD for evaluation. If the coursework cannot be determined to clearly compare with the United States semester system of credits and degrees awarded, DCD will send the applicant a request for an international education evaluation.*

* An internet search for international education evaluators will provide multiple sources for this service.

DCD Child Care Workforce Standards Section August 2009

NC DHHS Division of Child Development

ACCEPTABLE DEGREES AND COURSEWORK

 The following degrees** are accepted for lead teacher equivalency and for the Early Childhood/Child Development (EC/CD) coursework component for administrators:

o AA/AAS in Early Childhood/ Child Development; o BA/BS in Early Childhood/ Child Development/ Human Growth & Development/ B-K Education/ Early Childhood Special Education

** The degree earned must be shown on an official transcript, including the major and the date the degree was awarded. Copies of diplomas are not accepted as verification of degree completion.

For those who want to qualify as lead teachers but do NOT have one of the degrees listed or have no degree at all, the following criteria apply to coursework***: When reviewing transcripts for coursework to meet lead teacher equivalency and extra hours, evaluators look for courses that emphasize a developmental understanding of young children and developmentally appropriate educational approaches for the early years. This is why elementary education degrees and coursework often do not qualify for credit, and why such courses as Introduction to Education, Education in Society and Foundations of Education are also not given credit as EC/CD coursework. For the same reason, general education courses required for a degree are NOT counted. ***For child care administrators: the same criteria apply to evaluations of coursework to satisfy the EC/CD component and extra hours.

If an individual has not achieved a certificate, diploma or post-secondary degree, the coursework must be no more than ten years old at the time they submit their first application (an Education and Equivalency Form for any position) in order to be counted.

 Courses routinely counted as Early Childhood/Child Development include:

o most EDU courses in the NC Community College System except a group of vocational courses (EDU 175, 176, 178, 179, 240, 245, 250, 285)

o some ASL (American Sign Language) prefixes [limited to developmental language and communication skills]

o DDT 120 Teaching Developmental Disabled (in NC Community Colleges) o courses with Kindergarten (K) in the name

DCD Child Care Workforce Standards Section August 2009

NC DHHS Division of Child Development

DCD Child Care Workforce Standards Section August 2009

o some Psychology courses, including General, Introduction, Child Psychology and Child Development

 Additional courses counted for School-Age positions include:

o the same EDU prefixes in the NC Community College System that count for EC/CD except EDU 234 Infants, Toddlers and Twos

o the same Psychology courses plus Child/Adolescent Psychology and Child/Adolescent Development

o Elementary Education courses and degrees

 Practicums, internships and student teaching experiences are never counted as EC/CD courses, although they may have earned course credit toward a degree.

 Other courses may be considered for appropriateness, usually through review of course descriptions. If such coursework is deemed appropriate, credit will be given on a case by case basis.

GUIDELINES TO HIGH SCHOOL DIPLOMAS AND EQUIVALENTS

TO MEET MINIMUM EDUCATION REQUIREMENTS FOR CHILD CARE PROVIDERS

The requirement for completion of high school can be met through a number of options, as described below: High School Diploma, Home School Diploma, Adult High School Diploma, GED Credential. For additional assistance, please visit the Provider / Professional Development section of the North Carolina Division of Child Development website at www.ncchildcare.net.

 High School Diploma: this award recognizes completion of all state and local graduation requirements from regionally accredited high schools. The diploma may indicate a track (college prep, technical, occupational, etc.) that the student took to meet requirements. The diploma awarded is the same, regardless of the track taken.

High School Accreditation: high schools issuing diplomas must have nationally recognized regional accreditation in the United States. This is generally true for public high schools. It may or may not be true for private schools, including online and correspondence high schools. Diplomas from high schools without regional accreditation are not recognized by the Division of Child Development. An exception will be made when the high school is listed with the NC Division of Non-Public Education for the school year when the applicant graduated.

The recognized regional accrediting bodies for high school diplomas (and the geographic regions they serve) are: North Central and Southern Association CASI (commission on accreditation and school improvement) http://www.advanc-ed.org/schools_districts/ Arkansas, Arizona, Colorado, Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, Oklahoma, New Mexico, South Dakota, Wisconsin, West Virginia, and Wyoming, Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas and Virginia

DCD Child Care Workforce Standards Section March 2009

http://www.advanc-ed.org/schools_districts/

Middle States Commission on Secondary Schools http://www.css-msa.org/ Delaware, the District of Columbia (D.C), Maryland, New Jersey, New York, Pennsylvania, Puerto Rico and the U.S. Virgin Islands New England Commission on Public Secondary Schools http://cpss.neasc.org/ and New England Commission on Independent Schools http://cis.neasc.org/ (such as traditional boarding and day preparatory schools, private elementary schools, schools serving students with special needs, and religiously affiliated schools of many faiths) Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont Western Association of Schools and Colleges http://www.wascweb.org/ (secondary schools are listed under The Accrediting Commission for Schools) California and Hawaii, the territories of Guam, American Samoa, Federated States of Micronesia, Republic of Palau, Commonwealth of the Northern Marianas Islands, the Pacific Basin, and East Asia, and areas of the Pacific and East Asia where American/International schools or colleges may apply to it for service Northwest Association of Accredited Schools http://www.northwestaccreditation.org/schools/accredited.html (distance education, elementary, foreign nation, high, K-12, middle level, post secondary non-degree granting, residential, special purpose, supplementary education and travel education schools) Alaska, Idaho, Montana, Nevada, Oregon, Utah, and Washington.

 Graduation Certificate and Certificate of Achievement: these are high school exit documents for students who do not meet the requirements for a diploma. These documents are NOT recognized as high school diplomas or equivalents.

 Home School Diploma: this diploma is issued by a non-public school where the student receives academic instruction from his/her parent, legal guardian, or a member of the household in which the student resides. The chief administrator of the home school issues the diploma.

What is a legitimate home school? The NC Division of Non-Public Education is authorized by state law to receive home school notices of intent to begin initial operation and to terminate operation, and to annually inspect the school’s student attendance and nationally standardized achievement test result records. They provide a list of home schools by county at this website: http://www.ncdnpe.org/hhh301.htm

 Adult High School Diploma (Adult HSD): this diploma is issued through the community college system in most states. There are exceptions, and other colleges could

DCD Child Care Workforce Standards Section March 2009

http://www.css-msa.org/

http://cpss.neasc.org/

http://cis.neasc.org/

http://www.wascweb.org/

http://www.northwestaccreditation.org/schools/accredited.html

http://www.ncdnpe.org/hhh301.htm

be approved to issue adult high school diplomas. Colleges issuing adult high school diplomas must have nationally recognized regional accreditation in the United States. The nationally recognized regional accrediting bodies for colleges (and the geographic regions they serve) are:  Middle States Association of Colleges and Schools www.msche.org

Delaware, the District of Columbia (D.C), Maryland, New Jersey, New York, Pennsylvania, Puerto Rico and the U.S. Virgin Islands

 New England Association of Schools and Colleges www.neasc.org Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont

 North Central Association of Colleges and Schools www.ncahigherlearningcommission.org Arkansas, Arizona, Colorado, Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, Oklahoma, New Mexico, South Dakota, Wisconsin, West Virginia, and Wyoming

 Northwest Commission on Colleges and Universities www.nwccu.org Alaska, Idaho, Montana, Nevada, Oregon, Utah, and Washington

 Southern Association of Colleges and Schools www.sacscoc.org Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas and Virginia

 Western Association of Schools and Colleges www.wascweb.org (senior colleges and universities) and www.accjc.org (community and junior colleges) California and Hawaii, the territories of Guam, American Samoa, Federated States of Micronesia, Republic of Palau, Commonwealth of the Northern Marianas Islands, the Pacific Basin, and East Asia, and areas of the Pacific and East Asia where American/International schools or colleges may apply to it for service

 GED (General Education Development) Credential: the GED Tests measure the academic skills and knowledge expected of high school graduates in the United States. Successfully passing the tests results in award of a GED credential (which may be called a diploma, certificate, credential, or endorsement).  The only official GED is given by the GED TESTING SERVICE and its

approved sites. All approved testing locations are listed at www.GEDtest.org.  The official GED is not offered online via the internet. Currently the GED is a

paper and pencil test only. The GED test is a series of 5 tests covering different subjects and takes 7 hours to complete.

DCD Child Care Workforce Standards Section March 2009

http://www.msche.org/

http://www.neasc.org/

http://www.ncahigherlearningcommission.org/

http://www.nwccu.org/

http://www.sacscoc.org/

http://www.wascweb.org/

http://www.accjc.org/

http://www.gedtest.org/

DCD.0168 - 8/1/09

North Carolina Division of Child Development Credential Application Early Childhood Credential (NCECC), Family Child Care Credential (NCFCCC) and School-Age Child Care Credential (NCSACCC) (DCD.0168)

DCD Use Only WFID#

SSN (last 4 digits): Date of Birth (mm/dd/yy): A. APPLICANT INFORMATION—Fill in every blank or write N/A. Please print or type. / / Mr./Ms. First Name: MI: Last Name:

Maiden Name: Email Address:

Home Mailing Address (Include Apt # or lot #, if applicable): City: State: Zip:

Home Phone (include area code): Cell Phone (include area code): County of Residence:

( ) ( )

B. FACILITY EMPLOYMENT INFORMATION—If you are currently employed in a child care center or family child care home regulated by the Division of Child Development (DCD) you must provide all of the following:

Facility ID# (on license): Facility Name:

Facility Address: City: State: Zip:

Facility Phone #: Date of employment (at this facility): Date Employment ended: # of hours worked per week on a regular basis:

( ) / / / / Check one: 0-19 20-40 40+ Current position at this facility (check one):

Director Co-Director Asst. Director Family Child Care Home Provider Lead Teacher Teacher

Floater Program Coordinator Group Leader Other: Facility Name: If you were employed in a different DCD regulated facility at the time you

completed the Credential coursework, you must provide all of the following: Facility ID# (on license): Date of employment (at this facility): Date Employment ended: # of hours worked per week on a regular basis:

/ / / / Check one: 0-19 20-40 40+

C. EDUCATIONAL BACKGROUND—Check all that have been completed. Attach all college level official transcripts. Please check here if the NC Community College is mailing your official transcript separately.

High School Info (REQUIRED):

High School Diploma (HSD) Adult HSD GED Currently Enrolled None:

Year graduated from HS or GED Program:

Major: College: Major: College: AA/AAS

MA/MS

Major: College: Major: College: BA/BS

EdD/PhD

Are you currently enrolled in a NC Community College Early Childhood curriculum program? Yes No Name of NC Community College: ______________________________________________

If all or part of your educational expenses have been paid by a scholarship, please check all that apply:

TEACH Center Paid CDA Grant Other:____________________________________________________________

D. COURSE INFORMATION: Read the instructions for Section D. before proceeding! Course Code

Instructor’s Name or Signature Name of NC Community College where coursework completed

Date of Enrollment (mm/dd/yy)

Date Course Completed (mm/dd/yy)

# of Hrs. Absent

Grade

EDU 111 EDU 112 EDU 113 EDU 119 EDU 145 EDU 235 EDU 263

Note: Successful completion of the credential coursework in regard to the certificate is determined by the NC Division of Child Development and is subject to laws, rules and regulations in effect upon completion of individual courses. I understand that approval of my credential certificate is conditional upon, but not limited to, successful completion of the coursework and receipt of a high school diploma or GED.

***Check for accuracy, sign and date your application. Mail completed application with official transcripts. (see address on bottom of page 2) Please allow 8-12 weeks to receive your certificate.***

This statement must be signed and dated by applicant: I attest to the accuracy of the above information. Signature _____________________________________________________________________ Date: _____________________________

Applicant should retain a copy of this form and any attached documentation for his/her records.

Instructions for Credential Application (DCD.0168) 8/1/09, page 1 of 1

NC Credential Application for NCECC, NCFCCC and NCSACCC cont.

Please read these instructions carefully. (Keep this page for your reference.)

Incomplete forms will be returned and will delay processing. YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS FORM to be considered for a credential certificate. Please print clearly in ink or type your answers. If a question does not apply to you, write N/A (''Not Applicable'') in the space. Applicant should retain a copy of this form and any attached documentation for his/her records.

Section A. Applicant Information: Complete all requested information in this section. Please include your maiden name (if applicable). Do not abbreviate street names, cities or counties.

Section B. Facility Employment Information: Note: Students completing any credential coursework after 12/31/2008 who are not also on a T.E.A.C.H. scholarship will not receive a bonus award.

Section C. Educational Background: High School Information (this is a required field): Check one. To qualify for any of the credential certificates, the applicant must have a High School Diploma (from a regionally accredited high school), Adult High School Diploma or GED. High school diplomas do not need to be submitted unless specifically requested by DCD. Please know that DCD may request proof of high school diploma or GED at anytime. College: Check all that have been completed. Official transcripts must be attached for ALL completed college level coursework, certificates, diplomas and/or degrees. Please do not attach copies of in-service training documentation as these are not considered college coursework. Photocopies of transcripts, student or internet copies, and grade reports are NOT accepted. For any coursework over 10 years old to be counted, you must have earned a certificate, diploma or degree or be currently enrolled in a degree program with credit given on a current official transcript for this older coursework. *Accredited is defined as an institution of higher education having nationally recognized regional accreditation by one of the six regional accrediting agencies. (For schools outside the U.S.A., the recognized system of the specified country’s accreditation process will be accepted).

Section D. Course Information: Credential Certificates: NC Early Childhood Credential (NCECC) = EDU 111 and EDU 112 OR EDU 119 NC Family Child Care Credential (NCFCCC) = EDU 111 and EDU 113 OR EDU 113 and EDU 119 NC School-Age Child Care Credential (NCSACCC) = EDU 145 and EDU 235 OR EDU 145 and EDU 263

Credential Course Names: EDU 111—Early Childhood Credential I, EDU 112—Early Childhood Credential II, EDU 113—Family Early Child Credential, EDU 119—Introduction to Early Childhood Education, EDU 145—Child Development II, EDU 235—School-Age Development & Program, EDU 263—Development of School-Age Program

1. Instructor’s Name or Signature: Provide name of course instructor. If a course was completed before March 1, 2001,

the actual instructor or Early Childhood Department Chair must sign this form and fill in the appropriate boxes. 2. Name of NC Community College Where Coursework Completed: Provide name of NC Community College where you

enrolled in the course, not name of facility or building where course was held. 3. Date of Enrollment: Provide date of first class you attended for this course. Example: 01/15/02 NOT Spring 2002 4. Date Completed Course: Provide date of last class you attended for this course. Example: 12/15/02 NOT Fall 2002 5. # of Hrs. Absent: If you completed the course before July 1, 1999, the number of hours missed must be provided by

the instructor or department chair. 6. Grade: Attach official NC Community College transcripts to the form to verify course grades. NOTE:  To qualify for the NCSACCC, you must have completed EDU 145 and EDU 235 or EDU 263 after March, 1999.  All courses (EDU 111, EDU 112, EDU 119, EDU 113, EDU 145, EDU 235, and/or EDU 263) must be completed at a NC

Community College with a grade of C or better to qualify for a credential certificate.  Grade PE (Credit Received), CE (Credit by Exam) or EL (Experiential Learning) disqualifies you from receiving the credential

certificate.

Mail to: Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions? Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

North Carolina Division of Child Development Education and Equivalency Form for Child Care Administrators (DCD.0173) (See Instruction Page and Worksheet) Please print or type.

DCD Use Only WFID#

DCD.0173 – 8/1/09

SSN (Last 4 Digits Only): Date of Birth (mm/dd/yy): A) Applicant Information – Fill in every blank or write N/A / / Mr./Ms. First Name: MI: Last Name:

Maiden Name: Email Address:

Home Mailing Address (Include Apartment or Lot # if applicable): City: State: Zip Code: Home Phone #: Cell Phone #: County of Residence: ( ) ( )

Date Employed at Facility: County of Employment: B) Facility Information – Fill in every blank or write N/A / / Facility ID # (on license): Name of Facility: Facility Phone #: ( ) Facility Address: City: State: Zip Code: Current Position: Date Employed at Current Position:

Director Lead Teacher Teacher FCCH Provider Group Leader Program Coordinator Other _______________________________________ / /

C) Educational Background – Check high school information & completed degrees. Attach ALL college level official transcripts. Photocopies of transcripts, student or internet copies and grade reports are NOT accepted.

High School Information (Required): HS Diploma Adult HS Diploma GED Currently Enrolled None

Major: College: Major: College: AA/AAS

MA/MS

Major: College: Major: College: BA/BS

EdD/PhD

D) Educational Qualification – Check the Administrator type for which you are applying. Check one box in each of the three components to show how you meet or plan to meet the requirements for the selected level. All three components must be completed to be qualified. See worksheet on p. 2 for full requirements for each type and level of Administrator. (Level I is required by child care regulations.)

Select type of Administrator for which you wish to be evaluated: Birth – 12 yrs and/or School-Age (5 – 12 yrs only)

EDU 261 Completed Currently Enrolled/Plan to Complete Tested out of Adm I Plan to test AND

EDU 262 Completed Currently Enrolled/Plan to Complete Tested out of Adm II Plan to test OR

1. Administration Coursework

(same requirement for all 3 levels)

plus 6 sch-Child Care Administration Completed Currently Enrolled/Plan to Complete OR

9 sch-Business Administration Completed Currently Enrolled/Plan to Complete

Level I: 7 sch in EC/CD OR NCECC or equivalent and Director for 3 yrs (attach experience documentation)

Level II: AA/AAS in EC/CD OR AA/AAS in any major with 12 sch in EC/CD OR Currently enrolled in BA/BS, 60 sch completed with 12 sch in EC/CD

2(a). Coursework in Early Childhood Education/ Child Development (for Child Care Administrator

serving children Birth-12 yrs)

and/or Level III: BA/BS in EC/CD OR BA/BS in any major with 18 sch in EC/CD

Level I: 7 sch in EE/HD OR SACCC or NCECC or equiv & Director for 3 yrs (attach experience documentation)

Level II: AA/AAS in EE/HG&D OR AA/AAS in any major with 12 sch in EE/HG&D OR Currently enrolled in BA/BS, 60 sch completed with 12 sch in EE/HG&D

2(b). Coursework in Elementary Ed/Human Growth and Development (for School-Age Administrator

serving children 5 – 12 years only)

plus Level III: BA/BS in EE/HG&D OR BA/BS in any major with 18 sch in EE/HG&D

3. Portfolio (completed in administration

courses EDU 261 & 262 or independently)

Portfolio completed: Level I Level II Level III

or Plan to complete: Level I Level II Level III OR

Waived for all levels if Director/Co-director or Asst. Director for 5 years (attach experience documentation)

This statement must be signed and dated by the applicant: I attest to the accuracy of the above information.

Signature____________________________________________________ Date _______________________

Applicant should retain a copy of this form and any attached documentation for his/her records.

Instructions for Completing the North Carolina Education and Equivalency Form for Child Care Administrators (DCD.0173)

***This form only needs to be completed and submitted to the NC Division of Child Development (DCD) ONCE.***

Any future changes in the applicant’s personal information, facility information, education status or requests to qualify for additional child care positions indicated on this form should be submitted on a

Workforce Change of Information Form (DCD.0120).

Purpose: The North Carolina Education and Equivalency Form is an application used to gather identifying information and to request evaluation of your education in order to meet education standards for specific child care position(s). Note: This qualification is for education requirements only. It does not indicate compliance with age, pre- service, criminal record, medical or in-service training requirements.

Please read these instructions carefully. Retain a copy of this form and any attached documentation for your records.

General Instructions: Print clearly in ink or type your answers. If a question does not apply to you, write N/A (''Not Applicable'') in the space. This form should be completed fully, accurately, legibly and be signed by the applicant. Incomplete forms will be returned and delay processing of your education evaluation.

Section A. Applicant Information: Complete all requested information in this section. Please include your maiden name (if applicable). Do not abbreviate street names, cities or counties.

Section B. Facility Information: If you are currently employed in a child care center or family child care home regulated by DCD, you must provide all of the requested information. If you are not currently employed put N/A in the “Name of Facility” space and this section is complete.

Section C. Educational Background: Check ALL applicable spaces to indicate completion of high school requirements and post-secondary (college level) degrees earned as of the date this form is submitted to DCD. High school completion information is required no matter what level of education above high school has been attained. High school diplomas do not need to be submitted unless specifically requested by DCD.

Official transcripts* must be attached for ALL completed college level coursework, certificates, diplomas and/or degrees. Please do not attach copies of in-service training documentation as these are not considered college coursework. Photocopies of transcripts, student or internet copies, and grade reports are NOT accepted. For any coursework over 10 years old to be counted, you must have earned a certificate, diploma or degree or be currently enrolled in a degree program with credit given on a current official transcript for this older coursework.

*Only official transcripts from post-secondary schools which are accredited will be evaluated. Accredited is defined as an institution of higher education having nationally recognized regional accreditation by one of the six regional accrediting agencies. (For schools outside the U.S.A., the recognized system of the specified country’s accreditation process will be accepted).

Section D. Educational Qualification: Check the type of Administrator for which you wish to be evaluated. Child Care Administrators are qualified to direct programs serving children from birth to age twelve; School-Age Administrators may direct programs only serving children age five and up.

Every administrator must meet requirements in each of three components: 1) administration coursework, and 2) early childhood/child development coursework (birth-12 yrs) or elementary education/ human development coursework (5-12 yrs), and 3) portfolio. In each component, there are choices for how to satisfy the requirements. Check the box that shows how you meet or plan to meet that component. Note: Currently enrolled is defined as completion of coursework in the previous semester at that particular school or documentation from the college’s registrar confirming current enrollment in a curriculum program (not as a special student).

Level I is the mandatory minimum qualification for any administrator; Levels II and III are voluntary. See the Worksheet on page 2 of these instructions for all the options to meet each component at Levels I, II and III. Use this worksheet to determine how you currently meet each component and what you may still need in order to qualify at the level you want to achieve. If you choose to complete a portfolio independently, request a packet using the contact information below.

Failure to submit official transcripts for ALL completed college level coursework and degrees will result in a delay in processing and may affect your facility’s rated license education points.

This form must be signed and dated by the individual applicant.

Mail to: NC Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions? Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

Instructions for Child Care Administrators Education and Equivalency Form (DCD.0173) page 1 of 2

WORKSHEET for North Carolina Child Care Administrators (Keep this worksheet for your records.)

Child Care Administrators (applies to child care programs serving children from birth to age 12) Three Required

Components Level I Options

(Mandatory)  Level II Options

(Voluntary)  Level III Options

(Voluntary) 

1. Administration Coursework

plus 9 sch in Business Administration 9 sch in Business Administration 9 sch in Business Administration 7 sch in EC/CD  or AA/AAS degree in EC/CD  or BA/BS degree in EC/CD  or

AA/AAS degree in any major with 12 sch in EC/CD or

2. Early Childhood / Child Development

Coursework plus

NCECC or equivalent and child care director, co-director or assistant director for 3 years

Currently enrolled in BA/BS, 60 sch completed with 12 sch in EC/CD

BA/BS degree in any major with 18 sch in EC/CD

Level I Portfolio of 6 assignments or Level II Portfolio of 12 assignments or Level III Portfolio of 18 assignments or 3. Portfolio completed in

EDU 261/262 courses or independently

Level I Portfolio waived if child care director, co-director or assistant director for 5 years

Level II Portfolio waived if child care director, co-director or assistant director for 5 years

Level III Portfolio waived if child care director, co-director or assistant director for 5 years

School-Age Administrators (applies to child care programs ONLY serving children age 5 and older) Three Required

Components Level I Options

(Mandatory)  Level II Options

(Voluntary)  Level III Options

(Voluntary) 

1. Administration Coursework

plus 9 sch in Business Administration 9 sch in Business Administration 9 sch in Business Administration 7 sch in EE/HG&D or AA/AAS degree in EE/HG&D or BA/BS degree in EE/HG&D or

AA/AAS degree in any major with 12 sch in EE/HG&D

2. Elementary Ed/ Human Growth &

Development Coursework

plus

SACCC or NCECC or equivalent and child care director, co-director or assistant director for 3 years

Currently enrolled in BA/BS, 60 sch completed with 12 sch in ElemEd/HGD

BA/BS degree in any major with 18 sch in EE/HG&D

Level I Portfolio of 6 assignments or Level II Portfolio of 12 assignments or Level III Portfolio of 18 assignments or 3. Portfolio completed in

EDU 261/262 courses or independently

Level I Portfolio waived if child care director, co-director or assistant director for 5 years

Level II Portfolio waived if child care director, co-director or assistant director for 5 years

Level III Portfolio waived if child care director, co-director or assistant director for 5 years

KEY TO ABBREVIATIONS & TERMS EDU 261: Early Childhood Admin I course taught at NC Community Colleges EDU 262: Early Childhood Admin II course taught at NC Community Colleges NCECC: North Carolina Early Childhood Credential SACCC: North Carolina School-Age Child Care Credential NCECAC: North Carolina Early Childhood Administration Credential EC/CD: Early Childhood / Child Development EE/HG&D: Elementary Education / Human Growth and Development AA/AAS: Associate’s Degree BA/BS: Bachelor’s Degree MA/MS: Master’s Degree sch: semester credit hours Portfolio: a collection of activities that demonstrate administrative skill and competency. A packet of specified portfolio assignments is completed in EDU 261/262 or independently by an applicant.

Instructions for Child Care Administrators Education and Equivalency Form (DCD.0173) page 2 of 2

North Carolina Division of Child Development Education and Equivalency Form for Child Care Providers (DCD.0169) (Use for all positions except Administrator – See Instruction Pages) Please print or type.

DCD Use Only WFID#

DCD.0169 – 8/01/09

SSN (Last 4 Digits Only): Date of Birth (mm/dd/yy): A) Applicant Information – Fill in every blank or write N/A

/ / Mr./Ms. First Name: MI: Last Name:

Maiden Name: Email Address:

Home Mailing Address (Include Apartment or Lot # if applicable): City: State: Zip Code:

Home Phone #: Cell Phone #: County of Residence:

( ) ( )

Date Employed at Facility: County of Employment: B) Facility Information – Fill in every blank or write N/A

/ / Facility ID # (on license): Name of Facility: Facility Phone #:

( ) Facility Address: City: State: Zip Code:

Current Position: Date Employed in Current Position: Director Lead Teacher Teacher FCCH Provider

Group Leader Program Coordinator Other ___________________ / /

C) Educational Background – Check high school information & completed degrees. Attach ALL college level official transcripts. Photocopies, student or internet copies and grade reports are NOT accepted.

High School Information (Required): HS Diploma Adult HS Diploma GED Currently Enrolled None

Major: College: AA/AAS

Major: College: BA/BS

Major: College: MA/MS

Major: College: EdD/PhD

D) Educational Qualification – Check the position(s) for which you are applying to be qualified. Then check the option(s) for how you think you will meet qualifications. See instruction page for the education requirements of each position.

Position Qualification Options (Attach Documentation)

Lead Teacher NC Early Childhood Credential Equivalency Option

Teacher HS only ECE Coursework Lead Teacher qualified

FCCH Provider HS only ECE Coursework NC Family Child Care Credential Lead Teacher qualified

Group Leader HS + BSAC Currently Enrolled in BSAC

Program Coordinator

f 2 sch Child/Youth Dev AND 2 sch School-Age Programming School-Age Child Care Credential

Lead Teacher + BSAC Admin + BSAC

This statement must be signed and dated by the applicant: I attest to the accuracy of the above information.

Signature_____________________________________________________ Date _______________________

Applicant should retain a copy of this form and any attached documentation for his/her records.

Instructions for Completing the North Carolina Education and Equivalency Form for Child Care Providers (DCD.0169)

(Use for all positions except Administrator)

***This form only needs to be completed and submitted to the NC Division of Child Development (DCD) ONCE***

Workforce Change of Information Form (DCD.0120).

Note: This qualification is for education requirements only. It does not indicate compliance with age, pre-service, criminal record, medical or in-service training requirements.

Please read these instructions carefully. Retain a copy of this form and any attached documentation for your records.

Section A. Applicant Information: Complete all requested information in this section. Please include your maiden name (if applicable). Do not abbreviate street names, cities or counties.

Section C. Educational Background: Check ALL applicable spaces to indicate completion of high school requirements and post- secondary (college level) degrees earned as of the date this form is submitted to DCD. High school completion information is required no matter what level of education above high school has been attained. High school diplomas do not need to be submitted unless specifically requested by DCD.

Official transcripts* must be attached for ALL completed college level coursework, certificates, diplomas and/or degrees. Please do not attach copies of in-service training documentation as these are not considered college coursework. Photocopies of transcripts, student or internet copies and grade reports are NOT accepted. For any coursework over 10 years old to be counted, you must have earned a certificate, diploma or degree or be currently enrolled in a degree program with credit given on a current official transcript for this older coursework.

Section D. Educational Qualification: Check all child care positions for which you wish to be evaluated. To be qualified for a position you must meet the minimum education requirements shown for each position on page 2 of these instructions. Submit official transcripts and/or copies of any qualifying certificates, such as a BSAC or a nationally accredited credential certificate**. Failure to do this will result in a delay in processing and possibly affect your facility’s rated license education points.

**The nationally accredited credential certificate must meet the following criteria: 1)Nationally accredited and available in all 50 states, 2) Comprehensive in scope which is inclusive of the following six areas: child growth and development; professionalism; health and safety; creation of appropriate environments that enhance physical, emotional, social and cognitive development; developmentally appropriate learning activities; and working with families, 3) 120 clock (contact) hours of education and/or training, 4) Formal observation and/or portfolio assessment, 5) Standardized written assessment, and 6) Individually earned.

This form must be signed and dated by the individual applicant.

Mail to: NC Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions? Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

Instructions for Education and Equivalency Form for Child Care Providers (DCD.0169) 8/1/09, page 1 of 2

This chart shows the MINIMUM education requirements for the positions listed on the Education and Equivalency form. For some positions there is more than one way to meet these minimum requirements. Completion of high school or its equivalent is required for all positions.

LEAD TEACHER TEACHER FAMILY CHILD

CARE HOME PROVIDER

GROUP LEADER PROGRAM COORDINATOR

High School Diploma or equivalent AND EITHER: NC Early Childhood Credential (earned by completion of EDU 111 and 112 or EDU 119) OR One of the 5 equivalency options listed below:

1. Tested out of the Division of Child Development NCECC standardized equivalency test prior to 1/1/08.

2. Completed and hold a currently active nationally accredited credential certificate in child development, early childhood education or child care to include CDA, CCP and AMS or AMI Montessori (attach a copy of the certificate).

3. Completed a post-secondary two-year degree or higher in Early Childhood, Child Development, Human Growth & Development or Early Childhood Special Education from an accredited* institution of higher education.

4. Completed a post-secondary two-year degree or higher in any subject area with at least 6*** sch in Early Childhood Education and/or Child Growth & Development from an accredited* institution of higher education.

5. Completed 12 sch (with or without a degree) in Early Childhood, Child Development, Human Growth & Development and/or Early Childhood Special Education programs with at least 3*** sch in Child Growth & Development from an accredited* institution of higher education.

High School Diploma or equivalent only

High School Diploma or equivalent AND Basic School- Age Care Certificate (BSAC) (attach a copy of the certificate)

High School Diploma or equivalent AND EITHER: NC School-Age Child Care Credential (earned by completion of EDU 145 and either EDU 235 or EDU 263) OR 2 sch of Child/Youth Development courses and 2 sch of School-Age Program courses OR Lead Teacher qualification and BSAC (attach a copy of the certificate) OR Administrator qualification and BSAC (attach a copy of the certificate)

***The criteria for approving courses in Early Childhood Education and Child Growth & Development (ECE/CD) for the required six (6) sch in Option #4 and the specific three (3) sch required in Option #5 is for the course content to emphasize developmental understanding of young children, and/or developmentally appropriate educational approaches for the early years. When course content meets this criteria but the course title is not early childhood or age-specific, the course description will need to indicate that the course focuses on ages between birth and five years, and/or the early years, early childhood, preschool, and/or young children. The coursework needed for completion of Option #5 (12 sch) includes ECE/CD related coursework that does not necessarily emphasize birth through 5 years (example - General Psychology) with at least 3 sch specific to child growth & development.

sch - semester credit hours

Instructions for Education and Equivalency Form for Child Care Providers (DCD.0169) 8/1/09, page 2 of 2

N o r t h C a r o l i n a D i v i s i o n o f C h i l d D e v e l o p m e n t

Public School Preschool Staff Education Form for Administrators (DCD.0172) ( S e e i n s t r u c t i o n s o n p a g e 2 ) P l e a s e p r i n t o r t y p e .

DCD Use Only

WFID#

DCD.0172 – 8/01/09 page 1 of 2

SSN (Last 4 Digits Only): Date of Birth (mm/dd/yy): A) Administrator Applicant Information Fill in every blank or write N/A / / Mr./Ms. First Name: MI: Last Name:

Maiden Name (if applicable): Email Address:

Home Mailing Address (Include Apartment or Lot # if applicable): City: State: Zip Code:

Home Phone #: Cell Phone #: County of Residence:

( ) ( )

Facility ID # (on DCD license): B) School Information – Fill in every blank or write N/A

L.E.A. Name:

School Name:

School Mailing Address: City: State: Zip Code:

Telephone #: Fax #:

( ) ( ) Type of Program (please check all appropriate boxes):

Preschool Education Even Start Head Start Exceptional Children

Title I More at Four Other (Specify):

C) Educational Background – Complete high school information and all requested experience and post secondary (college level) education information below. Please note - copies of internet printouts, student transcripts or grade reports are NOT accepted as proof of education. Send copies of official transcripts only.

High School Information (Required): HS Diploma Adult HS Diploma GED None

Number of years as a child care and/or public school administrator: less than 5 years 5 years or more

Attained Licenses/Certificates/Credentials/Degrees (please check all appropriate boxes):

Standard Principal License/Certificate Exceptional Children Program Administration Certificate

Level III NCECAC or Equivalent

If you do not hold one of the above, please list degree(s) attained or in progress AND attach a photocopy of your official transcripts.

Degree(s):

Education verification without proof by receipt of official transcripts is only valid if this form is completed by the Principal of the School or the Superintendent of the School System and attested to by the signature of that person below. If not appropriately signed, official transcripts will be required before the evaluation process will proceed. If the program is not located in a school, the Superintendent of the School System is required to complete and sign this form. I certify that I have reviewed the official personnel documentation for the employee listed on this form and verify that the information contained therein is complete and accurate. _______________________________________________________________________ ________________________________ Signature Check one: Principal or Superintendent of Schools Date __________________________________________________________________________________ Printed Name

Applicant should retain a copy of this form and any attached documentation for his/her records.

Instructions for Completing the

North Carolina Division of Child Development Public School Preschool Staff Education Form for Administrator (DCD.0172)

***This form only needs to be completed and submitted to the NC Division of Child Development (DCD) ONCE.***

Workforce Change of Information Form (DCD.0120).

Purpose: The North Carolina Division of Child Development Public School Preschool Staff Education Form is an application used by Department of Public Instruction operated preschool programs to gather identifying information and to request evaluation of your education in order to meet education standards for specific child care position(s). Note: This qualification is for education requirements only. It does not indicate compliance with age, pre- service, criminal record, medical, in-service training requirements or having met any additional standards set forth by the Department of Public Instruction.

Please read these instructions carefully. Retain a copy of this form and any attached documentation for your records.

General Instructions: Print clearly in ink or type your answers. If a question does not apply to you, write N/A (''Not Applicable'') in the space. Incomplete forms will be returned and delay processing of your education evaluation.

Important Information - Read before signing: By agreement between the Division of Child Development and the Department of Public Instruction, education verification without proof by receipt of official transcripts is only valid if this form is completed by the Principal of the School or the Superintendent of the School System and attested to by the signature of that person on page 1. No other person in any other position is authorized to sign this form. If not appropriately signed, official transcripts will be required before the evaluation process will proceed. If the program is not located in a school, the Superintendent of the School System is required to complete and sign this form.

Section A. Administrator Applicant Information: Complete all requested information in this section. Please include your maiden name (if applicable). Do not abbreviate street names, cities or counties.

Section B. School Information: Please provide all of the requested information. The facility ID # can be found on the license issued by the Division of Child Development.

Section C. Educational Background: Check ALL applicable spaces to indicate completion of high school requirements and any of the credentials, post-secondary (college level) degrees, certificates and/or licenses earned as of the date this form is submitted to DCD. High school completion information is required no matter what level of education above high school has been attained.

Administrator (directs overall program) has attained a standard* Principal Certificate/License or Exceptional Children Program Certificate or a Level III North Carolina Early Childhood Administration Credential (NCECAC) or its equivalent.

All Administrators who have not attained (or who are in the process of attaining) the above license(s) or certification(s) must attach a copy of their college level transcripts. Such individuals may be contacted to submit additional information in order for the education evaluation to be completed. Only copies of official transcripts from post-secondary schools which are accredited will be evaluated. Accredited is defined as an institution of higher education having nationally recognized regional accreditation by one of the six regional accrediting agencies. (For schools outside the U.S.A., the recognized system of the specified country’s accreditation process will be accepted). For any coursework over 10 years old to be counted, you must have earned a certificate, diploma or degree or be currently enrolled in a degree program with credit given on a current official transcript for this older coursework.

*We will only accept standard licenses. Provisional licenses require copies of official transcripts to be submitted for education verification.

Mail to: NC Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions? Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

Instructions for Public School Preschool Staff Education Form for Administrators (DCD.0172) 8/1/09, page 2 of 2

N o r t h C a r o l i n a D i v i s i o n o f C h i l d D e v e l o p m e n t

Public School Preschool Staff Education Form for Teacher/Teacher Assistant (DCD.0171) ( S e e i n s t r u c t i o n s o n p a g e 2 ) P l e a s e p r i n t o r t y p e .

DCD Use Only WFID#

DCD.0171 – 8/01/09 page 1 of 2

SSN (Last 4 Digits Only): Date of Birth (mm/dd/yy): A) Teacher/Teacher Assistant Applicant Information Fill in every blank or write N/A

Check one: Teacher Teacher Assistant / /

Mr./Ms. First Name: MI: Last Name:

Maiden Name (if applicable): Email Address:

Home Mailing Address (Include Apartment or Lot # if applicable): City: State: Zip Code:

Home Phone #: Cell Phone #: County of Residence:

( ) ( )

Facility ID # (on DCD license): B) School Information – Fill in every blank or write N/A

L.E.A. Name:

School Name:

School Mailing Address: City: State: Zip Code:

Telephone #: Fax #:

( ) ( ) Type of Program (please check all appropriate boxes):

Preschool Education Even Start Head Start Exceptional Children

Title I More at Four Other (Specify):

High School Information (Required): HS Diploma Adult HS Diploma GED None

Attained Credentials/Degrees/Certificates/Licenses (please check all appropriate boxes):

NC Early Childhood Credential or Equivalent

AAS/ECE or higher Standard* Preschool Add-On Certificate

Standard* B-K License

If you do not hold one of the above, please list degree(s) attained or in progress AND attach a photocopy of your official transcripts:

Degree(s):

Education verification without proof by receipt of official transcripts is only valid if this form is completed by the Principal of the School or the Superintendent of the School System and attested to by the signature of that person below. If not appropriately signed, official transcripts will be required before the evaluation process will proceed. If the program is not located in a school, the Superintendent of the School System is required to complete and sign this form. I certify that I have reviewed the official personnel documentation for the employee listed on this form and verify that the information contained therein is complete and accurate. _____________________________________________________________________ ________________________________ Signature Check one: Principal or Superintendent of Schools Date __________________________________________________________________________________ Printed Name

Applicant should retain a copy of this form and any attached documentation for his/her records.

Instructions for Public School Preschool Staff Education Form for Teacher/Teacher Assistant (DCD.0171) 8/1/09, page 2 of 2

Instructions for Completing the

North Carolina Division of Child Development Public School Preschool Staff Education Form for Teacher/Teacher Assistant (DCD.0171)

***This form only needs to be completed and submitted to the NC Division of Child Development (DCD) ONCE.***

Workforce Change of Information Form (DCD.0120).

Purpose: The North Carolina Division of Child Development Public School Preschool Staff Education Form is an application used by Department of Public Instruction operated preschool programs to gather identifying information and to request evaluation of your education in order to meet education standards for specific child care position(s). Note: This qualification is for education requirements only. It does not indicate compliance with age, pre-service, criminal record, medical, in-service training requirements or having met any additional standards set forth by the Department of Public Instruction.

Please read these instructions carefully. Retain a copy of this form and any attached documentation for your records.

Section A. Teacher/Teacher Assistant Applicant Information: Indicate the position for which you are asking to be qualified. Complete all requested information in this section. Please include your maiden name (if applicable). Do not abbreviate street names, cities or counties.

Section B. School Information: Please provide all of the requested information. The facility ID # can be found on the license issued by the Division of Child Development.

Teacher (assigned to classroom and responsible for daily plans, etc.) Minimum requirements: Must have attained a NC Early Childhood Credential (NCECC) or its equivalent Enhanced requirements: Must have attained an AAS in Early Childhood Education (ECE) or higher, or a standard* Preschool Add-On Certificate or a standard* B-K License

Teacher Assistant (assigned to classroom for educational support) Minimum requirements: 18 years old and have attained a high school diploma Enhanced requirements: NCECC or its equivalent

All Teachers and Teacher Assistants who have not attained (or who are in the process of attaining) the above license(s) or certification(s) must attach a copy of their college level transcripts. Such individuals may be contacted to submit additional information in order for the evaluation to be completed.

Only copies of official transcripts from post-secondary schools which are accredited will be evaluated. Accredited is defined as an institution of higher education having nationally recognized regional accreditation by one of the six regional accrediting agencies. (For schools outside the U.S.A., the recognized system of the specified country’s accreditation process will be accepted.) For any coursework over 10 years old to be counted, you must have earned a certificate, diploma or degree or be currently enrolled in a degree program with credit given on a current official transcript for this older coursework.

*We will only accept standard licenses. Provisional Pre-K Add-On or B-K licenses require copies of official transcripts to be submitted for education verification.

Mail to: NC Division of Child Development Workforce Education Unit 2201 Mail Service Center Raleigh, NC 27699-2201

Questions? Call the Workforce Education Unit 919-662-4567 or 1-800-859-0829

Website: www.ncchildcare.net

Maintain Original Form in Employee Personnel File

DCD-0049

NOTICE CHILD CARE PROVIDER MANDATORY CRIMINAL HISTORY CHECK

North Carolina law requires that a criminal history check be conducted on all persons who provide child care in a

licensed or registered child care facility, and all persons providing child care in nonlicensed child care homes, or facilities that receive state or federal funds.

“Criminal history” includes county, state, and federal convictions or pending indictments of any of the following crimes:

the following Articles of Chapter 14 of the General Statutes: Article 6, Homicide; Article 7A, Rape and Kindred Offenses; Article 8, Assaults; Article 10, Kidnapping and Abduction; Article 13, Malicious Injury or Damage by Use of Explosive or Incendiary Device or Material; Article 26, Offenses Against Public Morality and Decency; Article 27, Prostitution; Article 39, Protection of Minors; Article 40, Protection of the Family; and Article 59, Public Intoxication; violation of the North Carolina Controlled Substances Act, Article 5 of Chapter 90 of the General Statutes, and alcohol-related offenses such as sale to underage persons in violation of G.S. 18B-302 or driving while impaired in violation of G.S. 20-138.1 through G.S. 20-138.5; or similar crimes under federal law or under the laws of other states. Your fingerprints will be used to check the criminal history records of the State Bureau of Investigation (SBI) and the Federal Bureau of Investigation (FBI).

If it is determined, based on your criminal history, that you are unfit to have responsibility for the safety and well-being

of children, you shall have the opportunity to complete, or challenge the accuracy of, the information contained in the SBI or FBI identification records.

If you disagree with the determination of the North Carolina Department of Health and Human Services on your

fitness to provide child care, you may file a civil lawsuit in the district court in the county where you live. Any child care provider who intentionally falsifies any information required to be furnished to conduct the criminal

history shall be guilty of a Class 2 misdemeanor.

PRIOR CONVICTION/PENDING INDICTMENT STATEMENT (Please check one)

____ I swear, under penalty of perjury, that I have been convicted of a crime and/or I have pending indictments or

pending charges that are not minor traffic violations.

____ I swear, under penalty of perjury, that I have not been convicted of a crime, nor have any pending indictments or

pending charges, other than a minor traffic violation.

I also swear that I am ______, am not ____ under a deferred prosecution agreement or on probation for a crime. If I have

been convicted of a crime, have pending indictments or pending charges, am under a deferred prosecution agreement,

have received a Prayer for Judgment, or am on probation for a crime, I understand that my employment is conditional

pending approval from the Division of Child Development. I also understand that I may submit to the Division of Child

Development additional information concerning the conviction or charges that could be used by the Division in making

the determination of my qualification for employment. The Division may consider the following in making their decision:

length of time since conviction; nature of the crime; circumstances surrounding the commission of the offense or offenses;

evidence of rehabilitation; number of prior offenses; and my age at the time of occurrence.

Signature Printed Name Date The Division of Child Development makes no representations regarding this person's eligibility to provide child care based solely on this Statement.

Maintain Original Form in Employee Personnel File

DCD-0049 INSTRUCTIONS

MANDATORY NOTICE STATEMENT

 Each employee must receive a statement concerning the mandatory criminal record check.

 Each employee must sign a Prior Conviction/Pending Indictment statement.  This form is a sample form and can be copied. Maintain an original form for

ongoing use as new employees are hired.  If you choose to develop your own form it must contain the text that is

substantially similar to the text on this form.  The signed form is to be kept in the provider’s personnel file.

DHHS – CRIMINAL RECORD CHECK UNIT Revised 11/08 (Computer version)

CRIMINAL RECORD BACKGROUND CHECK BASIC INSTRUCTIONS

INCLUDING FORMS & APPROVED COUNTY LIST FOR ELECTRONIC

FINGERPRINTING

Please maintain a copy of these instructions and blank forms for future use

The North Carolina Child Care Law (General Statute 110-90.2) requires a criminal record check for all child care operators and providers (which includes household members, age 16 and older) in licensed or regulated facilities and nonlicensed facilities approved to receive State or federal funds for providing child care. You must submit completed criminal record check forms immediately to the NC Division of Child Development (Division) for anyone in your program who has not submitted forms previously for the background check. The Law requires that completed forms for each new provider or employee be submitted to the Division no later than eight (8) working days after beginning work.

This version of the Criminal Record Background Check Instructions includes information for electronic fingerprinting. The SBI and certain local law enforcement agencies (LEA) have formed a partnership agreement that allows child care providers/applicants to have their fingerprints submitted electronically to the SBI for processing. This arrangement provides a higher quality of print impressions and reduces the possibility of rejected prints. It also reduces the response time for completing the criminal record background check when you and your employees use these agencies. Please follow the instructions carefully when submitting forms under this arrangement. Select agencies that are authorized to transmit your fingerprint impressions to the SBI can be found on the Approved Agency Guide. Please visit www.ncchildcare.net under the “DHHS Criminal Record Checks” link for updated list. Please call agency in advance for scheduled days and/or times.

What must be done to complete the check and meet the Law and Rules? (Also refer to the Supplemental Instructions if you are a potential owner/operator of a child care facility.)

MANDATORY NOTICE & PRIOR CONVICTION STATEMENT (Form DCD-0049)

 Each child care provider must be given a copy of a statement (Mandatory Notice) which explains that a criminal record check is required by Law. Each child care provider must sign a Prior Conviction/Pending Indictment statement that is to be kept in the provider’s personnel file. A sample Mandatory Notice statement and Conviction/Pending Indictment statement (one form, DCD-0049) is included in this packet.

http://www.sled.state.sc.us

DHHS – CRIMINAL RECORD CHECK UNIT Revised 11/08 (Computer version)

This form should be kept in the employee’s personnel file and is not to be mailed to the Division. The owner/operator must also keep a copy of his or her own statement on file. ITEMS TO BE COMPLETED FOR SUBMISSION TO THE DIVISION

1. FINGERPRINT CARD  Each child care provider (or household member) must complete at least one fingerprint

card for a SBI check. The type of fingerprint card that must be used is called the APPLICANT CARD and the form number is FD-258. The provider may be required to present a picture identification card at the time fingerprints are taken. Included in this mailing is a sample of how the card must be filled out and additional instructions on completing the other required information. The Division does not provide the cards. (See suggested locations listed on the sample page.)

 The fingerprint card must be mailed to the Division with other criminal record check items. Information should not be mailed to the SBI.

 The fingerprint card must not be folded when mailed to the Division.  If the provider has not lived in North Carolina for the last five (5) years in a row, the

fingerprint card will also be submitted to the FBI for a national check.  If you or your employees go to one of the law enforcement agencies identified on the

list of Agencies Approved For Electronic Fingerprinting, your prints will be processed electronically. You must have the required forms (4 & 5) completed and appropriately signed before the agency will take the fingerprints. A picture identification card must be presented to the agent. (See information below for Applicant Information [4] and Electronic Fingerprint Submission Release of Information [5] forms.) If the prints are processed electronically you will not receive a fingerprint card. The fingerprint impressions will be transmitted immediately to the SBI. The agent must sign the Electronic Fingerprint Submission Release and return it to the person being fingerprinted. It must to be mailed immediately to the Division with the other packet items.

 You may go to any of the approved counties on the list to request to have your

fingerprints transmitted electronically. (You are not required to be a resident of the county to have fingerprints taken.)

2. LOCAL OR COUNTY CRIMINAL RECORD REPORT  Each child care provider (or household member) must obtain a certified criminal record

check from the county in which they reside. The county of residence must be consistent with the provider’s current address as shown on the other forms. This county or local check must be obtained from the County Clerk of Court’s office and must have been done within the last 90 days (of date the forms are mailed to the Division). This type of record check is also known as a “certified name check." The record check must reflect the provider’s legal and current first and last name and must be consistent with the name written on all other criminal record check forms. (Record checks from local law enforcement or other criminal records agencies are not acceptable and will delay the process if submitted.) Providers who are out of state residents must get a certified report from the Clerk of Court of the Circuit or District Court in their county of residence, or the State Repository office for their state. South

DHHS – CRIMINAL RECORD CHECK UNIT Revised 11/08 (Computer version)

Carolina residents may contact the State Law Enforcement Division (SLED) at www.sled.state.sc.us. Virginia residents may contact the Virginia State Police (VSP) at www.vsp.state.va.us. Once obtained, the original certified record check from the Clerk of Court, SLED, VSP, or State Repository office must be submitted to the Division. A copy of the local record check must be kept in the employee’s personnel file. If there are criminal convictions indicated on the local check, this does not mean that the Division will automatically disqualify the person. However, an owner/employer may choose to use this information during their hiring process.

 If the child care provider has a conviction (guilty judgment or admission of guilt),

pending charge or indictment, is under deferred prosecution, has received a Prayer for Judgment, or is on probation for a crime, the provider can submit additional information for the Division to consider when making the decision to qualify or disqualify. This should be sent in at the same time the other forms are submitted. We urge each provider to do this so that a more complete history is known about the conviction or the pending case.

3. IDENTIFYING INFORMATION FORM – DHHS 004 (revision of DCD 0050) – WITH

RELEASE INFORMATION

 Each child care provider (or household member) must complete and submit an original Identifying Information Form DHHS-004 (bubble form). The information provided on this form must be consistent with all other forms. This form will be submitted to the Division and scanned by computer. The form must be completed with a No. 2 pencil and must not be folded, torn or mutilated. Please read the specific instructions on the form very carefully and review the form that each employee completes before mailing to the Division. Leaving a corresponding oval blank for a filled in box, or completing two or more blanks in one row, will cause incorrect information to be recorded or the form to be rejected. Unnecessary blank spaces should not be left between letters in a name as this will distort information. Information should be filled in consecutively in the boxes and ovals unless otherwise directed on the form. A photocopy may not be submitted. If you need additional forms, you may call the Division’s Raleigh office. You will be asked for your license ID #, mailing address, and contact information. Please do not place staples or make any marks or hole punches on any of the black marks on this form.

Help with completing the Identifying Information Form sheet:

Please list maiden name and all previous names used on the lines provided, if applicable.

#1 Write and fill in ovals for Name. Last name is first and must match the names on other

forms submitted for the person. (Please be consistent with hyphenation and dual last names.) #2 Write and fill in ovals for the person’s social security number. #3 Write and fill in ovals for the person’s date of birth. The year must be 4 digits. #4 Indicate the person’s gender. #5 Indicate the person’s race.

http://www.vsp.state.va.us

DHHS – CRIMINAL RECORD CHECK UNIT Revised 11/08 (Computer version)

#6 Must be answered: If the person has lived in North Carolina for less than 5 years in a row (up to the current year), this item must be answered “No.”

#7 Write and fill in ovals for the home mailing address. If needed, there is extra space for

the address on the bottom right hand side of the form. If the mailing address is a Post Office Box, please write the physical address in the extra space provided.

#8 The county code must match the current county where the person lives and the

address in item # 7. #9 Only mark one program type. #10 Choose only one job type.

Owner - owner or operator of the child facility or family child care home.

Employee - anyone employed by a child care facility or who assists the owner in a family child care home.

Household member over age 15 (they have had their 16th birthday) - one who lives in the home (on a permanent or temporary basis) and is not involved with child care. The Law does not require volunteers, contract persons, and any other employees not providing care to a child to submit forms to the Division. If you are unsure about who needs the check please contact your child care consultant or the Division’s Criminal Record Check (CRC) Unit.

#11 This number is listed on the child care facility license permit or noted in visit summaries left by your child care consultant (for church exempt programs). You should contact your child care consultant if you do not have a facility ID # and you are not the potential owner/operator of a new family child care home.

#12 Only local purchasing agencies and other programs approved by the Division are to

complete this section. #13 Write in the complete name, address and phone number of the child care facility, even

if it is a nonlicensed or family child care home. #14 Date of hire or employment at child care facility identified in box 13. For Family Child

Care Home, this is date home was opened or issued permit, or date of eligibility as a household member. For non-licensed home, this is date approved for subsidy funds.

“Authority for Release of Information (State and Federal Record Check)” This section must be signed (in blue or black ink) and dated by the person listed in item #1. If the person is under age 18, parental consent is also requested.

DHHS – CRIMINAL RECORD CHECK UNIT Revised 11/08 (Computer version)

Select & Print associated forms: Child Care Electronic Prints Form 1 (SBI Release) & Child Care Electronic Prints Form 2 (Applicant form) (Adobe reader required) from www.ncchildcare.net site, under “DHHS Criminal Record Checks” link on main page. REQUIRED FORMS- FOR ELECTRONIC FINGERPRINTING (REFER TO ITEM 1)

4. APPLICANT INFORMATION FORM

 Each child care provider who visits a law enforcement agency approved for electronic fingerprinting must take a completed Applicant Information form to the agency. The information on this form must be consistent with all other forms. The type of check required for “Reason fingerprinted” must be indicated by the provider, director or program agent before visiting the law enforcement agency. If the provider has lived in the state less than the last five (5) years in a row, or is a non-resident, a “state & federal” check is required and must be indicated on the form. The Applicant Information form may be retained by the agent after use.

5. ELECTRONIC FINGERPRINT SUBMISSION RELEASE OF INFORMATION (with SBI Letterhead) - Replacement for Fingerprint Card only

 Each child care provider who visits a law enforcement agency approved for

electronic fingerprinting must take a completed and authorized Electronic Fingerprint Submission Release of Information form. The provider (employee) must sign this form. The form must also be signed by the program owner, director or other agent to authorize the individual to be fingerprinted and have the fingerprints submitted to the SBI electronically. The owner/operator must authorize his or her own form. This form must be presented to the agent at time fingerprints are taken to be submitted electronically. A photo identification card is required before the prints are taken. The official taking the fingerprints must sign the original copy of the Electronic Fingerprint Submission Release to certify that the fingerprints were taken and return the form to the provider. You must submit the original certified copy to the Division with the other packet items when the fingerprints have been processed electronically. A copy must be kept in the employee’s personnel file.

ADDITIONAL INFORMATION Each provider who visits a local law enforcement agency approved to transmit fingerprints electronically must complete and take the required forms to the agency. The local law enforcement agency will not have blank forms. If the local agency is not able to process the fingerprints electronically the provider will be advised by the agent. Each provider (or household member) must have a complete criminal record check packet submitted to the Division. The Division will not accept an incomplete packet or items mailed separately. You can send in each individual’s complete packet separately, or send packets for some or all individuals at one time. All the forms for one provider should be stapled in the upper right hand corner to prevent forms from becoming mixed up and must not be folded. If an item is