Forms

Early education and before and after school child care providers may adapt this model letter to send to heatlh professionls to explain the need for the health professionals to complete required health forms. It one of the documents posted on the WellCareTrackerTM website. WellCareTrackerTM is a secure Internet software application developed and maintained by ECELS to evaluate and track health service reports to be sure that children are up-to-date with vaccines and screeniings. On the WellCareTrackerTM website, select the letter from the left pane under "Sample Letters." 

This form includes a list and brief explanation of occupational health risks for adults who work in early care and education settings. Particular attention should ge paid to advising women of child-bearing age about risks to an unborn baby from the pregnant woman's exposure to certain common infections that spread from young children to others. The form also describes the worker's obligation to have a health appraisal by a licensed health care provider. The health appraisal must address job-related health issues such as immunizations, physical limitations relevant to the adult's job and advice about illness and injury risks associated with work expectations. Reviewed and reaffirmed 6/2018.