DA Form 5761-r Family Child Care (Fcc) Risk Assessment Tool Observation

DA Form 5761-r - also known as the "Family Child Care (fcc) Risk Assessment Tool Observation" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 5761-r - was last revised on July 1, 1989. Download an up-to-date fillable PDF version of the DA 5761-r down below or look it up on the Army Publishing Directorate website.

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FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION
For use of this form, see AR 608-10; the proponent agency is DCSPER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, United States Code, Section 3013
AUTHORITY:
To provide information regarding prospective FCC Providers to CDS personnel for use in the certification
PRINCIPAL PURPOSE:
process.
Information provided may be released IAW the Army's blanket routine uses contained in AR 340-21.
ROUTINE USES:
Disclosure of requested information is voluntary; however, if information is not provided, certification of the
DISCLOSURE:
candidate may be denied.
SECTION I - PROVIDER
1. Describe what happens when you first arrive.
2. Who is in the house when you arrive? (Indicate the number and ages of all children, including family members and those in care, as well as
the number and sex of any other adults or family members present.)
3. Describe how the provider handles interruptions (e.g., the phone ringing, someone at the door, family member's, demands, etc.)
4. How does the provider handle crises, emergencies, the unexpected?
5. Describe the husband's presence/involvement in the day-to-day operations of the FCC home.
6. How are the provider's own children involved in the FCC program?
- What is your impression of the provider's health and well-being?
- What is your impression of the provider's attitude toward her work?
DA FORM 5761-R, JUL 1989
APD LC v1.10
FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION
For use of this form, see AR 608-10; the proponent agency is DCSPER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, United States Code, Section 3013
AUTHORITY:
To provide information regarding prospective FCC Providers to CDS personnel for use in the certification
PRINCIPAL PURPOSE:
process.
Information provided may be released IAW the Army's blanket routine uses contained in AR 340-21.
ROUTINE USES:
Disclosure of requested information is voluntary; however, if information is not provided, certification of the
DISCLOSURE:
candidate may be denied.
SECTION I - PROVIDER
1. Describe what happens when you first arrive.
2. Who is in the house when you arrive? (Indicate the number and ages of all children, including family members and those in care, as well as
the number and sex of any other adults or family members present.)
3. Describe how the provider handles interruptions (e.g., the phone ringing, someone at the door, family member's, demands, etc.)
4. How does the provider handle crises, emergencies, the unexpected?
5. Describe the husband's presence/involvement in the day-to-day operations of the FCC home.
6. How are the provider's own children involved in the FCC program?
- What is your impression of the provider's health and well-being?
- What is your impression of the provider's attitude toward her work?
DA FORM 5761-R, JUL 1989
APD LC v1.10
FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION (CONT'D)
SECTION II - PROVIDER-CHILD INTERACTIONS
7. How do the children behave around the provider and her family?
8. How does the provider care for children of differing ages, abilities and interests (e.g., infants, toddlers, preschoolers, and school-age
children)?
9. How does the provider react when a child breaks the rules?
10. How does the provider speak to a child who is misbehaving?
11. What type of physical contact does the provider have with a child who is misbehaving?
12. How does the provider react to a child who is crying?
13. Describe what happens at meal time.
14. How does the provider react to a child who has a toileting accident?
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DA FORM 5761-R, JUL 1989
APD LC v1.10
FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION (CONT'D)
SECTION II - PROVIDER-CHILD INTERACTIONS CONT'D
15. Describe the provider's diapering procedures.
16. Describe any instances of children who display behavior problems.
- What is your impression of the provider-child interactions you observed?
SECTION III - SUPERVISION
17. Where are the children during your visit?
18. Describe the type of indoor activities you see.
19. Describe the type of outdoor activities you see.
20. How does the provider use TV with the children, and for herself?
21. How does the provider keep children away from dangerous things and/or her personal possessions?
DA FORM 5761-R, JUL 1989
APD LC v1.10
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FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION (CONT'D)
SECTION III - SUPERVISION CONT'D
22. How are older children involved in the care and supervision of younger children?
23. Describe what happens at nap time?
-
What is your impression of the provider's supervision of the children in her care?
SECTION IV - ENVIRONMENT
24. Describe the condition and appearance of the house.
25. What type of space is provided for the children?
26. Could unknown adults and adolescents have access to children because of problems with the facility?
27. Could unknown adults and adolescents have access to children because of lack of supervision?
28. Could adults and adolescents known
to the provider have an opportunity to abuse children because of the choice of substitutes or
helpers?
29. Could adults and adolescents known
to the provider have an opportunity to abuse children because of lack of supervision?
DA FORM 5761-R, JUL 1989
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APD LC v1.10
FAMILY CHILD CARE (FCC) RISK ASSESSMENT TOOL OBSERVATION (CONT'D)
SECTION IV - ENVIRONMENT CONT'D
- What is your impression of the safety of the environment for children?
- What is your impression of the emotional "feel" of the environment?
SECTION V - PROVIDER-PARENT INTERACTIONS
30. What type of communication does the provider have with the parents of the children in her care?
31. What type of contracts does the provider have between herself and the parents of the children in her care?
32. How does the provider react when a parent is late to pick up his/her child?
33. How does the provider handle fee disputes with parents?
34. Describe the provider's methods for keeping daily attendance records.
- What is your impression of the provider-parent interactions?
DA FORM 5761-R, JUL 1989
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APD LC v1.10

Download DA Form 5761-r Family Child Care (Fcc) Risk Assessment Tool Observation

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