"Safety Plan - Licensed Family Child Care Homes" - Missouri

Safety Plan - Licensed Family Child Care Homes is a legal document that was released by the Missouri Department of Health and Senior Services - a government authority operating within Missouri.

Form Details:

  • Released on February 1, 2017;
  • The latest edition currently provided by the Missouri Department of Health and Senior Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Missouri Department of Health and Senior Services.

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Missouri Department of Health and Senior Services
Section for Child Care Regulation
SAFETY PLAN – LICENSED FAMILY CHILD CARE HOMES
Purpose: This form is provided as a guide to assist licensed family child care homes in
developing a safety plan, when a sex offender resides within 1,000 feet of their child care home.
The licensee may submit the below information in a different format to their assigned Child Care
Facility Specialist.
Name of Child Care Facility
DVN
Facility Physical Address
What date will the safety plan be implemented?
What actions will the licensee be taking to ensure the safety of the children? (Provide
details below.) Attach additional sheets, if needed.
Explain how caregivers will be informed of the safety plan. (Provide details below.)
Attach additional sheets, if needed.
(2/17)
SAVE
PRINT
RESET
Missouri Department of Health and Senior Services
Section for Child Care Regulation
SAFETY PLAN – LICENSED FAMILY CHILD CARE HOMES
Purpose: This form is provided as a guide to assist licensed family child care homes in
developing a safety plan, when a sex offender resides within 1,000 feet of their child care home.
The licensee may submit the below information in a different format to their assigned Child Care
Facility Specialist.
Name of Child Care Facility
DVN
Facility Physical Address
What date will the safety plan be implemented?
What actions will the licensee be taking to ensure the safety of the children? (Provide
details below.) Attach additional sheets, if needed.
Explain how caregivers will be informed of the safety plan. (Provide details below.)
Attach additional sheets, if needed.
(2/17)
Explain How the safety plan will be monitored? (Provide details below.) Attach
additional sheets, if needed.
Explain how you will inform the Section for Child Care Regulation of any changes to the
safety plan? (Provide details below.) Attach additional sheets, if needed.
Name of Person Completing the form
Relationship to facility
Telephone number of Contact Person
E-mail
Person Completing the form signature
Date
(2/17)
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