Physician Statement of Good Health for Child Care
This form is a Physician's Statement of Good Health for Child Care Center personnel. It ensures compliance with health regulations and the welfare of children. Easily fill it out, print, and submit it to ensure your eligibility in child care settings.
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How do I fill this out?
To fill out this form, begin by entering the date of the examination. Next, provide your name and address. Sign the form and ensure it is stamped by the physician’s office for verification.
How to fill out the Physician Statement of Good Health for Child Care?
1
Enter the date of the examination.
2
Fill in your name and address.
3
Confirm you are physically qualified to care for children.
4
Have the physician sign and print their name.
5
Ensure the physician's office stamp is affixed.
Who needs the Physician Statement of Good Health for Child Care?
1
Child care center employees need this form to verify their health status.
2
Parents may need it to ensure child care providers meet health standards.
3
Physicians use this form to document the health qualifications of employees.
4
Administrative staff in child care settings require it for compliance records.
5
Licensing agencies use this form to assess fitness for child care personnel.
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What are the instructions for submitting this form?
Submit this form via email to licensing@browardfl.gov, or fax to 954-357-4903. You can also submit it in-person at the Consumer Protection Division located at 1 North University Drive, Plantation, Florida 33324. For questions regarding submission, contact 954-357-4800 for assistance and guidance.
What are the important dates for this form in 2024 and 2025?
This form is valid for two years from the date of the physician's examination. It is important to check your timeline and ensure your health exam remains current for ongoing compliance. Always renew before the expiration date to maintain eligibility.
What is the purpose of this form?
The purpose of this form is to ensure that child care personnel are in good health to provide a safe environment for children. Additionally, it serves to fulfill state regulations regarding health screenings for individuals working with children. By completing this form, child care providers demonstrate their commitment to the well-being of the children in their care.
Tell me about this form and its components and fields line-by-line.
- 1. Date: The date of the physical examination.
- 2. Name of Examined: The full name of the individual being examined.
- 3. Address: The address of the individual being examined.
- 4. Physician's Signature: The signature of the examining physician.
- 5. Physician's Name: Printed name of the physician.
- 6. Physician's Office Stamp: The official stamp of the physician's office.
- 7. Physician's Address: Address of the physician's office.
- 8. Physician's Phone: Contact number for the physician's office.
What happens if I fail to submit this form?
Failing to submit this form can have significant implications for your eligibility to work in child care. It may result in your inability to obtain necessary clearances and can impact the operation of child care facilities. Timely submission ensures compliance with local regulations and maintains safety standards.
- Impact on Employment: Delays in submission can hinder your employment opportunities in child care settings.
- Regulatory Non-compliance: Children's safety may be compromised if all personnel do not meet health qualifications.
- Licensing Issues: Failure to submit can lead to complications during licensing inspections of child care facilities.
How do I know when to use this form?
- 1. Employment Applications: When applying for jobs in child care, this form verifies your health status.
- 2. Health Reviews: It may be required during periodic health reviews by child care facilities.
- 3. Licensing Requirements: Used for maintaining licensing compliance within child care programs.
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