Plan of Operation for Child Care (JFS 01250)

SECTION 1: GENERAL INFORMATION/SPACE

Name of Center/Provider

County

Address

State

Zip Code

Mailing Address (if different)

State

Zip Code

Name of Contact Person

Telephone Number

Contact Person’s Telephone Number

Proposed Date of Opening

Owner/Corporation if applicable

Proposed Hours of Operation

Proposed Days of Operation

Proposed Months of Operation

PLANNED ENROLLMENT

Planned enrollment
Age Categories	Number of Children Planned at Opening		Number of Groups Planned at Opening		Number of Children Planned at Capacity
Infants (0 - 18 mo)
Toddlers (18 mo - 3 yrs)
Preschoolers (3 yrs - school-age)
School-age Children (5 yrs - 14 yrs)Note: Fulltime is for evenings, weekends, school breaks, snow days, summer, etc.	Before School	After School	Before School	After School	Before School	After School

	Fulltime		Fulltime		Fulltime

Total Number of Child Care Staff Members Planned at Opening

INDOOR SPACE(Rules 5101:2-12-11 and 5101:2-13-11)

Centers:

Attach the diagram that was reviewed by the building department showing the indoor space used by the child care operation, including any notes made by the building department on the diagram. Indicate the following:

Exits/entrance/office spaces
Walls, partitions or half walls
Walls, partitions, or half walls that are moveable
Sinks and water fountains
Emergency exits and exits to the outdoor play space
Floor plan with room names/number
Restrooms
Diaper changing area with sink
Food preparation areas

Will the center care for children under the age of 2 ½ years? If yes, describe how the center will keep these children separated from other groups older than 2 ½ years.

Family Child Care Homes:

Attach the diagram showing the indoor space used for child care. Indicate the following:

Entrance and exits
Rooms that will be used for child care, including sleeping areas used by children
Restrooms
Diaper changing area with sink
Kitchen

For Type A only: This diagram shall be the diagram reviewed by the building department, including any notes made by the building department on the diagram.

OUTDOOR SPACE(Rule 5101:2-12-11 and 5101:2-13-11)

Diagram the space used for outdoor play. Indicate the following:

Include location of fence or barriers
Note gate locations, street locations, and parking lots
Sketch outdoor permanent play equipment which stays in space (i.e., slides, swings, sandboxes, etc.)
Include sidewalks, concrete, or blacktop areas

If the play space is away from the center/home, diagram the outdoor space used.

If the center has no onsite outdoor play space, then an indoor recreation area must be provided. Give dimensions of your indoor recreation area.

What type of protective fall surface will be used on the playground? (Fall surface needed under slides, swings, climbers, bouncers, etc.)

How is the play area enclosed or otherwise protected from traffic or other hazards?

Not Applicable: Program operates less than four consecutive daylight hours and will not provide outdoor play.

SECTION 2: PROGRAMMING AND POLICIES

TRANSPORTATION/FIELD TRIP SAFETY(Rules 5101:2-12-14 and 5101:2-13-14)

List the make and model of the program's vehicle(s) if applicable.

A contracted agency is used to transport children.YesNo

EVENING AND OVERNIGHT CARE(Rules 5101:2-12-21 and 5101:2-13-21)

Will the program be providing evening and/or overnight care? (Between 7:00 PM and 6:00 AM)YesNo

ADMINISTRATION OF MEDICATION(Rules 5101:2-12-25 and 5101:2-13-25)

Will the program administer medication, topical products or lotions?YesNo

If yes, describe the program's procedures for administering medication, and topical products or lotions. (Be sure to describe the plan for each type of product).

SECTION 3: FOOD REQUIREMENTS

MEALS AND SNACKS(Rule 5101:2-12-22 and 5101:2-13-22)

Will meals and snacks be prepared on site or brought in from another source?

Signature of Administrator/Provider

Date

PLAN OF OPERATION FOR CHILD CARE