"Ccdbg Health and Safety Training Certification Form" - Arkansas

Ccdbg Health and Safety Training Certification Form is a legal document that was released by the Arkansas Department of Human Services - a government authority operating within Arkansas.

Form Details:

  • Released on July 25, 2017;
  • The latest edition currently provided by the Arkansas Department of Human 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 printable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Human Services.

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Child Care and Development Fund (CCDF) 
Health and Safety Training Requirements
 
CERTIFICATION FORM 
Facility Name 
Facility License 
Number 
Facility Address 
City, State, Zip 
Name 
Job Title 
Date 
As Director/Owner, I confirm, under penalty of perjury, that all employees working within my 
facility, including caregivers and teachers, have received training on all of the required health and 
safety topics and that I will keep a copy of this certificate in my files. 
Signature 
Date 
***IMPORTANT NOTICES*** 
 Only one (1) certificate is needed per facility number
 Certificate must be kept on file at the facility
 New staff have ninety (90) days to complete requirements
Questions about the Health and Safety Requirements? 
Please contact the Family Support Unit at 1-800-322-8176.
CCDF Form 7/28/2016‐Rev. 7/25/2017 
Child Care and Development Fund (CCDF) 
Health and Safety Training Requirements
 
CERTIFICATION FORM 
Facility Name 
Facility License 
Number 
Facility Address 
City, State, Zip 
Name 
Job Title 
Date 
As Director/Owner, I confirm, under penalty of perjury, that all employees working within my 
facility, including caregivers and teachers, have received training on all of the required health and 
safety topics and that I will keep a copy of this certificate in my files. 
Signature 
Date 
***IMPORTANT NOTICES*** 
 Only one (1) certificate is needed per facility number
 Certificate must be kept on file at the facility
 New staff have ninety (90) days to complete requirements
Questions about the Health and Safety Requirements? 
Please contact the Family Support Unit at 1-800-322-8176.
CCDF Form 7/28/2016‐Rev. 7/25/2017