FMR HEALTH AND SAFETY PROTOCOL

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

ENVIRONMENTAL HEALTH & SAFETY KEY INDICATOR #1 - SAFE AND CLEAN FACILITIES

Classroom Observations

Healthy and Safe Facilities

Air Quality and Overall Sanitation - EnvHS 1.1

• Is fresh air available in rooms occupied by children?

  Yes

  No

  N/A

• Is the environment free of air pollutants, including, mold, smoke, lead, pesticides, asbestos, and herbicides, as well as solid and water pollutants.

  Yes

  No

  N/A

• Are chemicals for controlling pests used while children are present?

  Yes

  No

  N/A

• Are toileting and diapering areas separated from areas used for cooking, eating, and children's activities?

  Yes

  No

  N/A

Emergency Alert Systems and Fire Safety - EnvHS 1.1

• Is there a smoke detector system?

  Yes

  No

  N/A

• Was the smoke detector system tested within the last 12 months?

  Yes

  No

  N/A

• Are all draperies, curtains, and other, similar furnishings and decorations flame resistant?

  Yes

  No

  N/A

General Safety and Wellness - EnvHS 1.1

• Is the heating-and-cooling system designed to prevent injury to children and adults?

  Yes

  No

  N/A

• Are electrical outlets accessible to children designed to prevent shock through the use of covers, installation of child -protection outlets (e.g., tamper-resistant outlets), or use of safety plugs.

  Yes

  No

  N/A

• Are windows and glass doors constructed, secured, and adjusted to prevent children's injury and escape?

  Yes

  No

  N/A

• Are facilities, materials, and equipment free of any hazards that may cause harm to children, families, or staff?

  Yes

  No

  N/A

• Is lighting bright enough so children and adults can clearly see activities, materials, and pathways?

  Yes

  No

  N/A

• Are any unvented fuel-fired heaters present?

  Yes

  No

  N/A

Evacuation Routes and Emergency Procedures - EnvHS 1.2

• Are exit signs clearly visible?

  Yes

  No

  N/A

• Are exit signs illuminated?

  Yes

  No

  N/A

• Are evacuation routes clearly marked for both children and adults?

  Yes

  No

  N/A

• Are emergency procedures posted in this setting?

  Yes

  No

  N/A

Life Safety Code Requirements - EnvHS 1.3

• Are all classroom doors within 100 feet of the nearest exit?

  Yes

  No

  N/A

• Are all classroom doors within 50 feet of any point in the classroom?

  Yes

  No

  N/A

• Does the classroom have an exit that leads directly to the outside?

  Yes

  No

  N/A

• Does the classroom have at least one outside window for emergency rescue or ventilation?

  Yes

  No

  N/A

Center Observations

Healthy and Safe Facilities

Inspections - EnvHS 1.1

• Does the grantee conduct safety inspections of all facilities, including all indoor and outdoor learning environments?

  Yes

  No

  N/A

• Review the results of the most current safety inspection for the setting you are observing. Are there any issues that have yet to be identified?

  Yes

  No

  N/A

• How do staff address issues identified during safety inspections?

• How often does the grantee perform safety inspections?

  Monthly

  Semi-annually

  Annually

  Less frequent than annually

Air Quality and Overall Sanitation - EnvHS 1.1

• Is the environment free of air pollutants, including, mold, smoke, lead, pesticides, asbestos, and herbicides, as well as soil and water pollutants?

  Yes

  No

  N/A

• Does the program maintain a smoke-free environment on center grounds?

  Yes

  No

  N/A

• Are facilities, materials, and equipment free of any hazards that may cause harm to children, families or staff?

  Yes

  No

  N/A

• Does the program have a pest-management program?

  Yes

  No

  N/A

• Is all sewage and liquid waste disposed of so as not to expose children and adults?

  Yes

  No

  N/A

• Are garbage and trash stored in a safe and sanitary manner that does not allow easy access by children?

  Yes

  No

  N/A

• Are toilets and handwashing facilities clean, adequate in number, in good repair, and easily accessible by children?

  Yes

  No

  N/A

Emergency Alert Systems and Fire Safety - EnvHS 1.1

• Is a fire extinguisher available?

  Yes

  No

  N/A

• Is the extinguisher easily accessible?

  Yes

  No

  N/A

• Is there a service date on the fire extinguisher showing it has been updated at least annually?

  Yes

  No

  N/A

• Is there a fire alarm system that includes all the following?<br>* Manual means of initiation (e.g., pull boxes)<br>* Connection to the smoke detector systems<br>* Use of both audio and visual signals when activated

  Yes

  No

  N/A

• Was the fire-alarm system tested within the last 12 months?

  Yes

  No

  N/A

• Is there a smoke detector system?

  Yes

  No

  N/A

• Are smoke detectors located in all of the following areas:<br>* Each story, in front of doors to the stairway<br>* Corridors on all floors<br>* Lounges and recreation areas<br>* Sleeping rooms

  Yes

  No

  N/A

• Is emergency lighting available that allows children and adults to clearly see pathways in case of a power failure?

  Yes

  No

  N/A

Life Safety Code & Occupancy Requirements - EnvHS 1.3

• Does the building have an occupancy permit?

  Yes

  No

  N/A

• Does the grantee ensure that occupancy loads are calculated and posted for assembly spaces?

  Yes

  No

  N/A

• Does the center have an occupancy load of more than 50 persons?

  Yes

  No

  N/A

• Does the center have an occupancy load of more than 100 persons?

  Yes

  No

  N/A

• Does the building have an automatic fire-sprinkler system?

  Yes

  No

  N/A

• Do children or staff occupy the basement level of the building?

  Yes

  No

  N/A

• Are ceilings a minimum of 7 feet, 6 inches, with no projections protruding so as to provide less than 6 feet, 8 inches?

  Yes

  No

  N/A

• Are all doors used for entry and exit between 32 and 48 inches wide?

  Yes

  No

  N/A

• Are all corridors that lead to an exit a minimum of 36 inches wide?

  Yes

  No

  N/A

• Is every exit door equipped with panic hardware?

  Yes

  No

  N/A

• Do any exit doors have more than one locking or latching device?

  Yes

  No

  N/A

• Does each floor of the center have a minimum of two exits that lead to the outside?

  Yes

  No

  N/A

• Does the center have any dead-end corridors that exceed 20 feet in length?

  Yes

  No

  N/A

• Does the center have any dead-end corridors that exceed 50 feet in length?

  Yes

  No

  N/A

• Are all stairways a minimum of 44 inches wide? Applies to buildings with more than 50 occupants?

  Yes

  No

  N/A

• Are all stairways a minimum of 36 inches wide? Applies only to buildings with fewer than 50 occupants.

  Yes

  No

  N/A

Pre-Site Document Review

Licensing - EnvHS 1.3

• Does the program have a current child care license for this center of FCC home?

  Yes

  No

  N/A

Inspections - EnvHS 1.3

• How often are fire prevention inspections conducted?

  Annually

  Semi-annually

  Monthly

  Fire-prevention inspections are not conducted

• Did the program have a building inspection in the last 12 months?

  Yes

  No

  N/A

• Review the results of the most recent building inspection. Which of the following best describes the results of the inspection?

  Passed

  Passed with concerns

  Failed

ENVIRONMENTAL HEALTH & SAFETY KEY INDICATOR #2 - HEALTHY LEARNING ENVIRONMENTS

Classroom Observations

Safety and Cleanliness of Indoor and Outdoor Space - EnvHS 2.1

• Are toxic substances stored in a safe and secure manner in a locked room or cabinet fitted with a child resistant lock and inaccessible to children?

  Yes

  No

  N/A

• Are the following areas clean and free of dirt and debris?<br>* Carpets<br>* Floors<br>* Furniture<br>* Toys<br>* Materials<br>* Counter and shelves

  Yes

  No

  N/A

• Is there evidence of pests?

  Yes

  No

  N/A

• Were provisions made to ensure the safety, comfort, and participation of children with disabilities?

  Yes

  No

  N/A

• Does the classroom provide at least 35 square feet of usable indoor space per child (excluding bathrooms, halls, kitchens, staff rooms, and storage space)?

  Yes

  No

  N/A

• Are there any tip-over or tripping hazards in the room?

  Yes

  No

  N/A

• Are toys, materials, and furniture age-appropriate?

  Yes

  No

  N/A

• Are furnishings in the room sturdy and in good repair?

  Yes

  No

  N/A

• Does the program ensure that sleeping arrangements for infants (e.g., cribs, playpens, bassinettes) are free of soft bedding materials (e.g., soft mattresses, pillows, stuffed animals, fluffy blankets, comforters)? Applies only to programs serving infants and toddlers.

  Yes

  No

  N/A

Hand-washing - EnvHS 2.2

• Did you observe a situation that required handwashing? Check all situations you observed where handwashing should have occurred:

  Yes

  No

  N/A

• After diapering or toilet use

• Before food preparation

• Whenever hands were contaminated with blood or other bodily fluids

• After handling pets or other animals

• After handling garbage

• Did handwashing occur at the appropriate times and include the following?<br>* Staff assisting children as needed<br>* Staff and/or children washing hands with soap and water

  Yes

  No

  N/A

Spilled Bodily Fluids - EnvHS 2.3

• If bodily fluids were spilled during your observation, did clean-up include all of the following?<br>* Nonporous gloves worn<br>* Spills/fluids cleaned up immediately<br>* All areas cleaned and sanitized<br>* Contaminated materials placed in a plastic bag and secured

  Yes

  No

  N/A

Diapering - EnvHS 2.4

• If diapering was observed, did staff do all of the following when changing diapers?<br>* Before bringing the child to the diaper-changing area, washed hands and brought supplies to the diaper-changing area<br>* Always kept a hand on the child<br>* Cleaned the child's diaper area<br>* If wearing gloves, changed gloves prior to putting on clean diaper<br>* Washed the child's hands and returned the child to a supervised area<br>* Cleaned and disinfected the diaper-changing surface<br>* Washed hands

  Yes

  No

  N/A

Proper Handling of Breast Milk - EnvHS 2.5 Applies only to program serving infants and toddlers

• Are any children currently on breast milk or formula?

  Yes

  No

  N/A

• Is breast milk properly refrigerated and all containers labeled with the child's full name and the date the breast milk was collected?

  Yes

  No

  N/A

• Is frozen breast milk defrosted in the refrigerator?

  Yes

  No

  N/A

• Is formula stored in the original container and labeled with the child's full name and date opened?

  Yes

  No

  N/A

Medication Management - EnvHS 2.6

• Are any children currently receiving medication?

  Yes

  No

  N/A

• Are over-the-counter medications in original containers, and does the program have written orders from a physician that includes dosage and length of time to administer the medication?

  Yes

  No

  N/A

• Are non-emergency medications stored under lock and key?

  Yes

  No

  N/A

• If children are currently receiving medication, compare labeling information noted on the Medication Administration Log. Are all medications given as prescribed?

  Yes

  No

  N/A

• Are prescribed medications in original containers with original prescription labels?

  Yes

  No

  N/A

• Are all medications within their dates of expiration?

  Yes

  No

  N/A

Center Observations

Safety and Cleanliness of Indoor and Outdoor Space - EnvHS 2.1

• Does the design of the playground and equipment promote the safety of children, including:<br>* Appropriate height and accessibility?<br>* No openings that could entrap a child's head or limbs?<br>* Equipment on shock-absorbing surface?<br>* Absence of sharp edges, rust, choking, and/or strangulation hazards, garbage, and hazardous material (e.g., glass, needles, animal feces)?<br>* Equipment is stable and/or secured to the ground?

  Yes

  No

  N/A

• Are toxic substances stored in a safe and secure manner in a locked room or cabinet fitted with a child-resistant lock and inaccessible to children?

  Yes

  No

  N/A

Interview: Nutrition Coordinator

Proper Handling of Breast Milk - EnvHS 2.5

• Describe how the program: * Meets the individual nutritional needs and feeding requirements of all children * Complies with USDA nutrition requirements * Addresses special dietary needs of children * Accommodates the feeding and nutritional needs of children with disabilities * Ensures that foods posing a high risk of choking for infants and toddlers (e.g., hot dogs, whole grapes, hard raw vegetables, popcorn, whole nuts) are not given to them

Pre-Site Document Review

USDA Inspections - EnvHS 2.5

• Did the program have a USDA inspection in the last 12 months?

  Yes

  No

  N/A

• Review the results of the most recent USDA inspection. Which of the following best describes the results of the inspection?

  Passed

  Passed with concerns

  Failed

ENVIRONMENTAL HEALTH & SAFETY KEY INDICATOR #3 - SAFE LEARNING ENVIRONMENTS AND SUPERVISION

Document Review - Criminal Record Check Tracking System

Criminal Record Checks - EnvHS 3.1

• Review the Criminal Record Check (CRC) tracking document to ensure all staff have CRC's and the CRC's were completed prior to the staff person being hired.

• Are there any staff who do not have a CRC?

  Yes

  No

  N/A

• Are there any staff hired within the last 12 months who did not complete a CRC prior to being hired?<br>Please select up to 10 staff from the CRC tracking document who were hired within the last 12 months. Enter the staff's name, date of hire, and date of CRC completion from the tracking document for each of the 10 selected staff members. Share the list of staff with the grantee so the CRC documentation can be available for the Reviewer for on-site validation.

  Yes

  No

  N/A

Interview - Head Start Director

Appropriate Release - EnvHS 3.5

• With the Head Start Director, review the program's documented policies and procedures regarding the release of children and the emergency contact list of authorized parents and guardians to whom children can be released. * How do teaching staff know which adults are authorized to pick up children? * How do bus staff know which adults are authorized to pick up children when they get off the bus and where each child is supposed to be dropped off? * What process is in place to release children from the center or FCC setting? * How is information to support the process kept up to date? Is the information easily accessible?

• In the past 12 months, has a child been released to an unauthorized adult or dropped off at the wrong location?

  Yes

  No

  N/A

• When did the incident occur?

  Date

• Was the incident reported to the Regional Office?

  Yes

  No

  N/A

• What was the result of the report to the Regional Office?

Supervision and Positive Guidance - EnvHS 3.6

• In the past 12 months, has a child been left unsupervised?

  Yes

  No

  N/A

• When did the incident occur?

  Date

• Was the incident reported to the Regional Office?

  Yes

  No

  N/A

• What was the result of the report to the Regional Office?

• In the past 12 months, has a staff member used corporal punishment, emotional or physical abuse, humiliation, unnecessary restraint, isolation, or denial of food, water, or bathroom privileges?

  Yes

  No

  N/A

• When did the incident occur?

  Date

• Was the incident reported to the Regional Office?

  Yes

  No

  N/A

• What was the result of the report to the Regional Office?

Interview - Transportation Coordinator

Appropriate Release - EnvHS 3.5

• With the Transportation Coordinator, discuss how the program ensures children are released to authorized adults at the correct locations. * How do the staff know which adults are authorized to pick up children when they get off the bus and where each child is supposed to be dropped off? * What process is in place to appropriately release children as they get off the bus?

Classroom Observation

Preschool-Age Group Ratio - EnvHS 3.2

• What is the predominant age of children in the class, as determined at the start of the program year?

• How many staff members are assigned to this classroom or group?

• How many children are enrolled in the classroom according to the program's documentation?

• How many children are currently present in the classroom?

Infant/Toddler Group Ratio - EnvHS 3.3 Applies only to programs serving infants and toddlers

• How many infants/toddlers are currently present in the group?

• How many staff members are currently present with the group?

Supervision - EnvHS 3.6

• Are staff within arm's reach of children sitting in a high chair or on a changing table, and holding any children who are bottle-feeding?

  Yes

  No

  N/A

• Are all on-duty staff supervising and engaging with children in a way that ensures the children's safety?

  Yes

  No

  N/A

• Did you observe an instance in which a child or children were unsupervised?

  Yes

  No

  N/A

• Are clear systems in place to account for the whereabouts of each child (e.g., attendance logs and sign-in/out sheets, routine head counts)?

  Yes

  No

  N/A

Positive Guidance - EnvHS 3.6

• Did staff use positive child guidance when responding to undesired child behaviors rather than corporal punishment, emotional or physical abuse, unnecessary restraint, humiliation, isolation, or denial of food, water, or bathroom privileges?

  Yes

  No

  N/A

Center Observation

Safe Outdoor Play Areas - EnvHS 3.4

• Are outdoor play areas arranged so adults can see children and effectively supervise to prevent children from leaving and/or getting into unsafe areas?

  Yes

  No

  N/A

Risk-Assessment Guide

Inappropriate Release - EnvHS 3.5

Incident Details

• How was the child released? Select all that apply.

• Child was dropped off at the wrong location.

• Child was released to the wrong adult.

• Child was left unattended.

• Where was the child released inappropriately?

• Bus stop

• Home or alternate faciltiy

• Center or FCC

• How old was the child when the incident occurred?

Cause

• Please describe what happened and why a child was released inappropriately.

• Typically, what should have happened? Please email the Review Field Lead (RFL) a copy of the program's release procedures.

• How do staff know their role in ensuring children are released safely and to the correct person?

• In what way, and how often, do you check in with staff to ensure they follow the program's release procedures?

• Based on the above information, select the option that best explains why a child was released inappropriately:

• There was no system in place to ensure that children were released to an authorized adult.

• A system existed and was followed correctly, but a child was released inappropriately.

• A system existed, but staff did not follow the system.

Time

• Ask the program for specific documentation or evidence regarding the length of time the child was alone or with an unauthorized adult. Please describe the evidence submitted.

• Based on the evidence submitted by the program, how long was the child left alone or with a unauthorized adult.

  Select 1-5 minutes 6-15 minutes 16-29 minutes 30 or more minutes Time was unknown, or evidence was not provided by the program

  • 1-5 minutes
  • 6-15 minutes
  • 16-29 minutes
  • 30 or more minutes
  • Time was unknown, or evidence was not provided by the program

Effect

• Please indicate which of the following occurred. Select all that apply.

• The child was seriously injured.

• The child was exposed to harsh conditions (e.g., extreme weather conditions).

• The child was found by someone other than Head Start staff.

• The child was left alone.

Reporting

• When did the program report the incident to the Regional Office?

  Select The day the incident occurred One to 3 days after the incident More than 3 days after the in ixent The program did not report to the Regional Office

  • The day the incident occurred
  • One to 3 days after the incident
  • More than 3 days after the in ixent
  • The program did not report to the Regional Office

• The day the incident occured

• One to 3 days after the incident occurred

• More than 3 days after the incident occurred

• The program did not report to the Regional Office

• Did the program report this incident to the child's legal guardian?

  Yes

  No

  N/A

• Did the program report this incident to the licensing agency?

  Yes

  No

  N/A

• Is the program required to report to the licensing agency?

  Yes

  No

  N/A

Supervision - EnvHS 3.6

Incident Details

• Where was the child left unsupervised?

  Select Classroom Bathroom Lunchroom Hallway Playground Left center (i.e., was inside and went outside; was outside and left the premises) Left behind wandered off from a field trip Left on bus Other

  • Classroom
  • Bathroom
  • Lunchroom
  • Hallway
  • Playground
  • Left center (i.e., was inside and went outside; was outside and left the premises)
  • Left behind wandered off from a field trip
  • Left on bus
  • Other

• How old was the child when the incident occurred?

Cause

• Please describe what happened and why a child was left alone.

• Typically, what should have happened.

• Please email the RFL a copy of the program's supervision procedures.

• How do staff know their role in ensuring children are always supervised?

• In what way, and how often, do you check in with staff to ensure they follow the program's supervision procedures?

• Based on the information above, select the option that best describes why a child was left alone:

• There was no system in place to ensure children were supervised at all times.

• A system existed and was followed correctly, but a child was left alone.

• A system existed, but staff did not follow the system.

• There were not at least two adults supervising the group of children prior to the child being unsupervised.

• The teacher sent the child to another location, such as the bathroom or on an errand (i.e., the teacher knew where children were, but they were unsupervised).

Time

• Ask the program for specific documentation or evidence regarding the length of time the child was alone. Please describe the evidence submitted by the program.

• Based on the evidence submitted by the program, how long was the child left unsupervised?

  1-5 minutes

  6-15 minutes

  16-29 minutes

  30 or more minutes

  Time was unknown, or evidence was not provided by the program

Effect

• Please indicate which of the following occurred. Select all that apply.

• The child was seriously injured.

• The child walked off the premises or away from a field trip.

• The child was exposed to harsh conditions (e.g., extreme weather conditions).

• The program did not know the child was alone.

• The child was found by someone other than Head Start staff.

• The program knew the child was alone.

• The program's system detected the missing child (e.g., program had a back-up, redundant system, and it worked).

Reporting

• When did the program report this incident to the Regional Office?

  Select The day the incident occurred One to 3 days after the incident More than 3 days after the in ixent The program did not report to the Regional Office

  • The day the incident occurred
  • One to 3 days after the incident
  • More than 3 days after the in ixent
  • The program did not report to the Regional Office

• Did the program report this incident to the child's legal guardian?

  Yes

  No

  N/A

• Did the program report this incident to the licensing agency?

  Yes

  No

  N/A

• Is the program required to report to the licensing agency?

  Yes

  No

  N/A

Inappropriate Punishment - EnvHS 3.6

Cause

• Please describe what happened and why the incident occurred?

• Typically, what should have happened?

• Has the staff member had other issues prior to this incident?

• Prior to this incident, were any supports provided to the staff member (e.g., mental health consultation, additional staff in the room, coaching, etc.)?

• What was the effect of these supports?

Effect

• What was the outcome of this incident for the child and the staff involved?

Reporting

• When did the program report this incident to the Regional Office?

  Select The day the incident occurred One to 3 days after the incident More than 3 days after the in ixent The program did not report to the Regional Office

  • The day the incident occurred
  • One to 3 days after the incident
  • More than 3 days after the in ixent
  • The program did not report to the Regional Office

• Did the program report this incident to the child's legal guardian?

  Yes

  No

  N/A

• Did the program report this incident to the licensing agency?

  Yes

  No

  N/A

• Is the program required to report to the licensing agency?

  Yes

  No

  N/A

ENVIRONMENTAL HEALTH & SAFETY KEY INDICATOR #4 - SAFE TRANSPORTATION

Bus Inspection

Safety Equipment - EnvHS 4.1 Applies only to programs providing Transportation services.

• Is the bus equipped with a reverse beeper?

  Yes

  No

  N/A

• Is the bus equipped with a two-way communication system?

  Yes

  No

  N/A

• Is the bus equipped with safety equipment for use in an emergency, including a charged fire extinguisher that is properly mounted near the drivers seat with a sign indicating its location?

  Yes

  No

  N/A

• Is the bus equipped with a first aid kit and a sign indicating its location?

  Yes

  No

  N/A

• Is the bus equipped with a seatbelt cutter for use in emergency evacuation and a sign indicating its location?

  Yes

  No

  N/A

• Is the bus equipped for use of height- and weight-appropriate child restraint systems?

  Yes

  No

  N/A

Interview - Transportation Services Coordinator

Bus Monitor - EnvHS 4.2 Applies only to programs providing Transportation services

• Ask the Transportation Coordinator to describe the process for assigning bus monitors.

• How many bus monitors are assigned to each route? What information is considered when making assignments?

• How do bus monitors support the safe transportation of children with special needs? Are there times when more than one bus monitor is required? If yes, describe under what circumstances this might occur.

Bus Monitor Training - EnvHS 4.3 Applies only to programs providing Transportation services

• Review the programs documentation of training for bus monitors - including topics and date(s) training was received - with the Transportation Coordinator. Training topics should include:

• Child boarding-and-exiting procedures

• Use of child restraint systems (Note: lap belts are not appropriate.)

• Required paperwork

• Emergency and evacuation procedures

• Use of special equipment

• Child pick-up and release procedures

• Confirm that bus monitors are not scheduled for duty until required training is completed. If this is not the case, ask the Transportation Coordinator to describe why this occurred and document the training date(s) and date(s) bus monitors were scheduled.

Bus Driver Training - EnvHS 4.4 Applies only to programs providing Transportation services

• Ask the Transportation Coordinator to describe the training plan for staff employed to drive vehicles. Does the training include a combination of classroom and behind-the-wheel instruction sufficient to enable each driver to do all of the following?

• Operate the vehicle in a safe and efficient manner

• Safely run a fixed route, including loading and unloading children, stopping at railroad crossings, and performing other specialized driving maneuvers

• Administer basic first aid in case of injury

• Handle emergency situations, including vehicle-evacuation procedures

• Operate any special equipment, such as wheelchair lifts, assistive devices, and special occupant restraints

• Conduct routine maintenance and safety checks of the vehicle

• Maintain accurate records as necessary

• Ask the Transportation Coordinator when staff are scheduled to transport children relative to their training date(s).