Wisconsin licensed child care centers must show that staff who work with children have had a health exam. This one-page DCF report records the examiner's two certifications: that the person appears free of illness, including tuberculosis, that spreads through normal contact, and that they appear physically able to work with children. The signed form goes back to the staff member for the center's staff file.
The examining health professional, an MD, PA or other HealthCheck provider, completes and signs Section B, Physical Examination. Section A holds the staff member's name and position title.
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Staff Health Report - Licensed Child Care Centers
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According to the form, in family child care centers the provider, employees and substitutes, and in group child care centers the persons who work directly with children, except volunteers. Use of this particular DCF form is voluntary, but completing it meets the exam requirement in DCF 250.05 and 251.05.
The signature line is for an MD, PA or other HealthCheck provider who examined the staff member. The examiner checks yes or no for two statements, freedom from symptoms of communicable disease and physical ability to work with children, adds any comments, then signs and dates the form.
The form does not ask for a tuberculin test result. The examiner certifies, based on the examination, that the person appears free of symptoms of illness, including tuberculosis, or communicable disease that may be transmitted through normal contact.