Template Field Operations Guide



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Pediatric Safe Area Checklist





YES

NO

ITEM







Needle boxes are at least 48 inches off the floor?







Do the windows open?







Are the windows locked?







Are there window guards?







Plug-in covers or safety wiring for electrical outlets?







Are choking hazards and cords removed?







Strangulation hazards removed (cords, wires, tubing, and curtain/blind drawstrings)?







Can children be contained in this area (consider stairwells, elevators, doors)?







Are there activities for the children (age and gender appropriate videos, games, toys)?







Have you poison-proofed the area (cleaning supplies, Hemoccult developer)?







Are your med carts and supply carts locked?







Do you need to create separate areas for various age groups?







Is there a plan for security for the area?







Is there a plan to identify the children?







Is there a plan for assessing mental health needs of these children?







Are there any fans or heaters in use? Are they safe?







Is there an onsite or nearby daycare? Could they help you?







Is there enough staff to supervise the number of children (younger children will require more staff)?







Do the staff have age-appropriate experience?







Is there a sign-in/sign-out sheet for all children and adults who enter the area?







Will children need to be escorted from the childcare area to bathrooms?







Are age-appropriate meals and snacks available for children?







Are there considerations for life-threatening allergies?







Are various-sized diapers available?







Are there hand hygiene supplies?







Are there cribs, cots or beds available for children who need to sleep?







Is there a policy/protocol for handling minor illness in children (Tylenol dosing, administering routine meds, etc.).


Childcare Area Sign In/Out Sheet


Name of Child

Age

Sign In Time

Sign Out Time

Responsible Adult Name

Responsible Adult Signature

Contact Phone Number

Special Instructions











































































































































































































































































































































































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