Rev. 8/2013
Kansas Department of Health and Environment
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: 785-296-1270 Fax: 785-296-0803
Website: www.kdheks.gov/kidsnet
RECORD OF OBSERVATIONS
Incomplete record of observations will not be accepted as meeting the requirement. PLEASE PRINT.
First and Last Name of the Individual Completing the Observations
Name of the Individual’s Work Site Facility (exactly as it appears on the license)
Street Address of Work Site Facility
City
License #
Zip Code
County
REQUIREMENT: Complete five observations for 2.5 hours each for a total of 12.5 hours. All parts of the day should be observed
(morning, lunch, nap, play). Observations are not to be made at the work site or at a facility owned by the individual observing.
1.
Primary care providers completing the requirements for a for a Licensed Day Care Home may complete observations in a
Licensed Day Care Home or Group Day Care Home or Licensed Child Care Center that has been in continuous operation for 3 or more years.
2.
Primary care providers completing the requirements for a Licensed Group Day Care Home may complete observations in a
Group Day Care Home or Licensed Child Care Center that has been in continuous operation for 3 or more years.
3.
Staff completing requirements for a Child Care Center, Preschool, Head Start Program or School Age Program for a unit (or) facility with fewer than 13 children may complete observations in a Licensed child care facility with children of the same age as enrolled in present facility.
4.
Staff completing requirements for a Child Care Center, Preschool, Head Start Program or School Age Program for a unit (or) facility with up to 24 children may complete observations in a Licensed Child Care Center, Preschool, Head Start Program or
School Age Program.
RECORD OF OBSERVATION - All blanks must be completed.
Name of