Directions: Use this checklist to observe and document competencies that specifically address supporting children with special health needs. As you observe and reflect on a staff member’s practice, indicate how often the staff member performs the following actions using the scale provided. Share your observations with staff and use the information learned from the checklist to identify goals and focus your coaching interactions.

Note: The term “children” is used throughout this checklist to refer to any individual between the ages of 6 weeks and 12 years of age.

1. Staff member can describe and discuss the care plans of each child who enters the program with an identified health care need.
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2. Staff member implements care plans as prescribed.
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3. Staff member is aware of allergies and take steps to prevent contact with allergens.
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4. Notices regarding allergies are clearly and prominently posted in the child’s classroom or program space and wherever children eat.
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5. Staff member checks the “Rights” of medication before administering medication.
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6. Staff member follows all program policies regarding medication.
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7. Staff member takes a copy of the plan, the proper medication, and a cell phone whenever the child leaves the building.
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8. Staff member can describe and discuss the care plans of each child who enters the program with an identified health care need.
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9. Staff member implements care plans as prescribed.
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