Homepage Ohio Jfs 01296 Template in PDF

Documents used along the form

The Ohio JFS 01296 form is essential for ensuring that employees in child care settings meet health requirements. However, several other forms and documents often accompany it to provide a comprehensive view of an employee's qualifications and health status. Below is a list of these related documents, each serving a unique purpose in the hiring and compliance process.

  • Employee Health History Form: This document collects detailed information about an employee's past medical conditions, allergies, and any medications they are currently taking. It helps employers assess potential health risks in a child care environment.
  • Background Check Authorization Form: Required for all child care employees, this form allows employers to conduct background checks. It ensures that individuals with a history of offenses that could endanger children are not hired.
  • Power of Attorney for a Child Form: This important document allows parents or guardians to temporarily authorize another adult to make decisions on behalf of their child, including those related to healthcare and education. For more details and to obtain the form, you can visit Texas PDF Forms.
  • Immunization Records: This document provides proof of an employee's vaccinations, including Tdap and MMR. It is crucial for verifying compliance with health regulations specific to child care settings.
  • CPR and First Aid Certification: A copy of the employee's certification in CPR and First Aid is often required. This training equips staff to respond effectively to emergencies involving children.
  • Child Abuse Registry Check: This form verifies whether an employee has been reported for child abuse. It is a critical step in ensuring the safety of children in care.
  • Employment Application: The application gathers basic information about the candidate, including work history, education, and references. It serves as the foundation for evaluating qualifications.
  • Reference Check Form: This document is used to contact previous employers or personal references to assess the applicant's character and work ethic. It helps ensure that the candidate is a good fit for a child care environment.
  • Training Verification Form: This form documents any additional training the employee has completed, such as child development courses or specialized training in handling children with special needs.
  • Emergency Contact Form: Employees provide information about whom to contact in case of an emergency. This ensures that there is a plan in place for immediate communication if needed.
  • Workplace Safety Policy Acknowledgment: Employees sign this form to confirm they have received and understood the workplace safety policies. It emphasizes the importance of maintaining a safe environment for both staff and children.

Each of these documents plays a vital role in the hiring process and helps maintain a safe and compliant child care environment. By ensuring that all necessary forms are completed and submitted, child care centers can provide a secure and nurturing atmosphere for children and peace of mind for parents.

Dos and Don'ts

When filling out the Ohio JFS 01296 form, it's essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do.

  • Do ensure that the physical examination occurs within 12 months of the first day of employment.
  • Do verify that the employee is immunized against Diphtheria/Tetanus/Pertussis (Tdap) and Measles, Mumps, and Rubella (MMR).
  • Do print the name of the health care provider clearly in the designated area.
  • Do include the health care provider's contact information, including street address, city, state, and zip code.
  • Do ensure that the form is signed and dated by a licensed health care provider.
  • Don't forget to sign the form yourself if required.
  • Don't leave any sections of the form blank; all information must be completed.
  • Don't submit the form without confirming that all immunization requirements are met.
  • Don't use a health care provider who is not authorized to sign the form.
  • Don't wait until the last minute to complete the form; allow ample time for any necessary examinations.

Key takeaways

When filling out the Ohio JFS 01296 form, which is the Employee Medical Statement for Child Care Centers and Type A Homes, keep the following key points in mind:

  • The form is required by Ohio Administrative Code rules 5101:2-12-25 and 5101:2-13-25.
  • It must be completed no more than 12 months prior to the employee's first day of work.
  • Ensure that the employee's name and home address are clearly filled out at the top of the form.
  • The health care provider must certify the employee's physical fitness for working in a child care facility.
  • Verification of immunizations against Diphtheria/Tetanus/Pertussis (Tdap) is mandatory for all employees.
  • Employees must also be immunized against Measles, Mumps, and Rubella (MMR), with specific exceptions for those born on or before December 31, 1956.
  • A history of mumps or measles disease can substitute for the vaccine for eligible individuals, but not for rubella.
  • Laboratory tests demonstrating detectable rubella antibodies can serve as proof for rubella vaccination.
  • The form must be signed by a qualified health care provider, such as a licensed physician or a certified nurse practitioner.
  • Make sure to include the health care provider's contact information, including their street address, city, state, zip code, and phone number.

Completing this form accurately is crucial for compliance with state regulations and ensuring the safety and health of children in care.

Similar forms

The Ohio JFS 01296 form serves as an important document in the context of child care employment. Several other documents share similarities with it in terms of purpose and requirements. Below is a list of nine such documents:

  • Employee Health Screening Form: This document is used to assess the health status of employees before they begin working, ensuring they meet health standards similar to those outlined in the JFS 01296.
  • Child Care Employee Immunization Record: This record tracks the immunizations of child care employees, confirming compliance with health requirements akin to the immunization details required by the JFS 01296.
  • Physical Examination Report: A general report documenting the results of a physical examination for any employment context, similar in nature to the health assessment required by the JFS 01296.
  • Health Care Provider Certification: This certification confirms that a health care provider has evaluated an employee's fitness for work, paralleling the certification aspect of the JFS 01296.
  • Child Care Licensing Application: This application requires health and safety documentation, including employee health statements, reflecting the licensing requirements outlined in the JFS 01296.
  • Background Check Authorization Form: While focused on criminal history, this form is also a prerequisite for child care employment, emphasizing the importance of safety in child care environments.
  • Staff Training Record: This document tracks required training for child care employees, ensuring they are prepared for their roles, similar to how the JFS 01296 prepares employees for health standards.
  • Rental Application Form: To streamline the leasing process, complete the required Rental Application for your new home to provide landlords with necessary tenant information.
  • Emergency Contact Information Form: This form collects crucial contact details for employees, enhancing safety protocols in child care settings, much like the health considerations in the JFS 01296.
  • Child Care Provider Agreement: This agreement outlines the responsibilities and requirements for child care providers, including health-related obligations that resonate with the JFS 01296.