Form CCL.207 "Record of Observations" - Kansas

This version of the form is not currently in use and is provided for reference only.
Download this version of Form CCL.207 for the current year.

What Is Form CCL.207?

This is a legal form that was released by the Kansas Department of Health & Environment - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Kansas Department of Health & Environment;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CCL.207 by clicking the link below or browse more documents and templates provided by the Kansas Department of Health & Environment.

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Download Form CCL.207 "Record of Observations" - Kansas

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Kansas Department of Health and Environment
CCL. 207
Rev. 3/2017
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: 785-296-1270 Fax: 785-559-4244
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)
License #
Street Address of Work Site Facility
City
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 Observation Site and
Date
Age of
Begin & End
Signature of
License Number
of Visit
Children or
Time
Teacher Observed
Youth
of Observation
Observed
I attest, under penalty of perjury, that the information completed on this form is true and correct.
Signature of Individual Completing Observations
Date Signed (MM/DD/YYYY)
Kansas Department of Health and Environment
CCL. 207
Rev. 3/2017
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: 785-296-1270 Fax: 785-559-4244
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)
License #
Street Address of Work Site Facility
City
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 Observation Site and
Date
Age of
Begin & End
Signature of
License Number
of Visit
Children or
Time
Teacher Observed
Youth
of Observation
Observed
I attest, under penalty of perjury, that the information completed on this form is true and correct.
Signature of Individual Completing Observations
Date Signed (MM/DD/YYYY)