An Administrator's Guide to California Private School Law

Chapter 21 – Child Care Centers/Preschools

k. Health Screening Report – Facility Personnel (LIC 503) 2633 This form verifies the health of the applicant(s) and site director to effectively perform their required duties. Each applicant and director and must submit this form. If the applicant is a corporation, the board president, chief executive officer, or lead person designated by the board must complete this form. A qualified medical professional must sign and date the form within one year of its submission to CCLD. A separate tuberculosis test verification will be required if the form’s tuberculosis test and result section is not completed. l. Emergency Disaster Plan (LIC 610) 2634 This plan must be developed by the applicant to enable the facility to handle any emergency and to protect the safety and well-being of each child. The form sets forth staff members’ assignments during an emergency and must identify a relocation site away from the facility that can accommodate the number of children in the facility. If the use of the relocation site requires an agreement with another entity or person, that agreement must be verified in writing. A copy of this plan must also be posted near a telephone in a prominent location in the facility. m. Earthquake Preparedness Checklist (LIC 9148) 2635 This form identifies earthquake safety measures and must be attached to the Emergency Disaster Plan (LIC 610). This form is primarily an educational and safety tool and is not a requirement for obtaining or keeping a license. Applicants are encouraged, but not required, to implement the procedures listed on the checklist. The CCLD will not, however, monitor a facility for compliance with any of the provisions of this checklist. 2636 n. Facility Sketch (LIC 999) 2637 This form is required for all indoor and outdoor space. The front of the form is a floor plan to identify the preschool’s indoor space. The floor plan must: (1) show the dimensions of all rooms; (2) designate the use for all rooms (e.g. kitchen, bathroom, classroom, etc.); (3) circle the names of rooms to be used by children and staff; (4) show door and window exits in case of an emergency; (5) identify rooms to be used by non-ambulatory children, if any; and (6) identify the location and number of toilets and sinks. The back of the form is used to provide a sketch of the yard and identify the outdoor space. This sketch must show: (1) all buildings in the yard, including the facility, garage, and storage areas; (2) driveways, fences, gates, gardens, playgrounds, and other outdoor space intended for use by children; and (3) location and dimensions of major equipment or items, such as playground

equipment, garbage storage, and swimming pools or other bodies of water. o. Local Fire Inspection Authority Information (LIC 9054) 2638

This form is only necessary if the applicant intends to serve non-ambulatory children or children with disabilities or special health care needs. If applicable, the CCLD will use this form to contact the local fire inspection authority to obtain a fire safety inspection.

An Administrator’s Guide to California Private School Law ©2019 Liebert Cassidy Whitmore 624