Fill a Valid Ohio Jfs 01296 Form

The Ohio JFS 01296 form is a crucial document required by the Ohio Department of Job and Family Services for child care centers and type A homes. This form certifies that an employee has undergone a physical examination and meets specific health requirements before starting their role in child care. It ensures that all staff members are fit for employment and properly immunized against certain diseases.

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Preview - Ohio Jfs 01296 Form

Ohio Department of Job and Family Services

EMPLOYEE MEDICAL STATEMENT

FOR CHILD CARE CENTERS AND TYPE A HOMES

The completion of this form is required by Ohio Administrative Code rules 5101:2-12-25 and 5101:2-13-25 that govern the licensing of child care centers and type A homes. The physical examination and completion of this form must occur no more than 12 months prior to the first day of employment.

Name of Employee

Home Address

First Day of

Employment

My signature below certifies that I examined the above-named person who is found to be:

1.Physically fit for employment in a facility caring for children

2.Immunized against Diphtheria/Tetanus/Pertussis (Tdap).

(All employees must have verification of being immunized against pertussis by January 2, 2017)

3.Immunized against Measles, Mumps and Rubella (MMR).

(Except that for a person born on or before December 31, 1956, a history of mumps or measles disease may be substituted for the vaccine. A history of rubella disease shall not be substituted for rubella vaccine. Only a laboratory test demonstrating detectable rubella antibodies shall be accepted in lieu of rubella vaccine.)

Name of Health Care Provider *(Please print)

Street Address:

City, State, Zip

Phone Number

Signature of Health Care Provider*

Date of Examination

*This form may be signed by a licensed physician, a physician's assistant, advance practice nurse or a certified nurse practitioner.

This is a sample form that meets the requirements of Ohio Administrative Code rules 5101:2-12-25 and

5101:2-13-25 that govern the licensing of child care centers and type A homes.

JFS 01296 (Rev. 9/2011)

Document Properties

Fact Name	Details
Purpose	The Ohio JFS 01296 form serves as an Employee Medical Statement required for individuals working in child care centers and Type A homes.
Governing Laws	This form is governed by Ohio Administrative Code rules 5101:2-12-25 and 5101:2-13-25, which outline licensing requirements for child care facilities.
Examination Timeline	A physical examination must be completed no more than 12 months prior to the employee's first day of work.
Immunization Requirements	Employees must provide proof of immunization against Diphtheria/Tetanus/Pertussis (Tdap) and Measles, Mumps, and Rubella (MMR).
Substitutions for Vaccines	For individuals born on or before December 31, 1956, a history of mumps or measles may replace the vaccine, but not for rubella. A lab test showing detectable rubella antibodies is required instead.
Authorized Signatories	The form can be signed by a licensed physician, a physician's assistant, an advanced practice nurse, or a certified nurse practitioner.

Documents used along the form

The Ohio JFS 01296 form is essential for ensuring that employees in child care settings meet health and safety standards. Alongside this form, several other documents may be required to complete the licensing process for child care centers and type A homes. Below are some commonly used forms that complement the JFS 01296.

Ohio JFS 01300 - Child Care Center Application: This application form is used to apply for a license to operate a child care center. It collects information about the facility, staff, and the services offered to children.
Ohio JFS 01301 - Type A Home Application: Similar to the JFS 01300, this form is specifically for individuals seeking to operate a Type A home, which is a smaller, family-style child care setting. It outlines the applicant’s qualifications and the home environment.
New York Room Rental Agreement: Understanding the necessity of formal agreements is vital for both landlords and tenants. For detailed templates and information, visit smarttemplates.net/.
Ohio JFS 01298 - Employee Orientation Training Record: This document records the training completed by employees in child care settings. It ensures that all staff members receive necessary training in areas such as child development and safety protocols.
Ohio JFS 01295 - Child Care Center Staff Qualifications: This form verifies the qualifications and background of staff members working in child care centers. It includes information on education, experience, and any relevant certifications.

Each of these documents plays a crucial role in maintaining the health, safety, and quality of care in child care environments. Completing them accurately helps ensure compliance with Ohio regulations and promotes the well-being of children in care.

Guidelines on Filling in Ohio Jfs 01296

After gathering the necessary information and ensuring you have the required documentation, you can proceed to fill out the Ohio JFS 01296 form. This form must be completed by a licensed health care provider and is essential for employment in child care settings. Follow the steps outlined below to ensure accurate completion.

Begin by entering the Name of Employee at the top of the form.
Next, fill in the Home Address of the employee.
Indicate the First Day of Employment in the designated space.
The health care provider should then certify the employee's fitness for employment. They will need to check the box indicating that the employee is:

Physically fit for employment in a facility caring for children
Immunized against Diphtheria/Tetanus/Pertussis (Tdap)
Immunized against Measles, Mumps, and Rubella (MMR)

In the section for the health care provider’s information, print the Name of Health Care Provider.
Complete the Street Address, City, State, Zip, and Phone Number of the health care provider.
The health care provider must sign the form and include the Date of Examination.

Once the form is filled out, it should be submitted to the relevant authority as part of the employment process in child care centers or type A homes. Ensure that all information is accurate and complete to avoid any delays in processing.

Common mistakes

Filling out the Ohio JFS 01296 form correctly is crucial for compliance with state regulations regarding child care employment. However, many individuals make common mistakes that can lead to delays or issues with licensing. Understanding these pitfalls can help ensure a smoother process.

One frequent error is failing to provide accurate personal information. Applicants sometimes overlook the importance of entering the correct name, home address, and first day of employment. Inaccuracies can result in confusion and may require additional steps to rectify the information. Always double-check these details before submitting the form.

Another mistake is not obtaining the required medical examination within the specified timeframe. The form mandates that the physical examination must occur no more than 12 months prior to the first day of employment. If the examination is outdated, the application will be deemed incomplete, which can delay the hiring process.

Additionally, applicants often neglect to ensure that all immunization records are complete and properly documented. The form requires verification of immunizations against Diphtheria/Tetanus/Pertussis and Measles, Mumps, and Rubella. Missing or incorrect documentation can lead to significant complications, especially if the applicant was born on or before December 31, 1956, as alternative documentation is allowed for some vaccines but not others.

Another common oversight involves the signature of the health care provider. The form must be signed by a licensed physician, physician's assistant, advance practice nurse, or certified nurse practitioner. Sometimes, applicants mistakenly have the form signed by someone who does not meet these qualifications, which renders the form invalid.

Lastly, individuals may forget to include the health care provider's contact information. The form requires a street address, city, state, zip code, and phone number. Omitting any of this information can hinder communication between licensing authorities and the health care provider, potentially delaying the approval process.

FAQ

What is the Ohio JFS 01296 form?
The Ohio JFS 01296 form is an Employee Medical Statement required for individuals seeking employment in child care centers and Type A homes. It ensures that employees meet health standards as outlined in Ohio Administrative Code rules.
Who needs to complete this form?
Any employee who will work in a child care center or Type A home must complete this form. This includes teachers, caregivers, and support staff who will be responsible for the care of children.
What are the health requirements specified in the form?
The form requires that the employee be:
- Physically fit for employment in a facility caring for children.
- Immunized against Diphtheria/Tetanus/Pertussis (Tdap).
- Immunized against Measles, Mumps, and Rubella (MMR).
For those born on or before December 31, 1956, a history of mumps or measles disease may substitute for the vaccine, but not for rubella.
How often must the form be completed?
The form must be completed no more than 12 months prior to the first day of employment. This ensures that the health information is current and relevant.
Who can sign the form?
The form must be signed by a licensed physician, a physician's assistant, an advanced practice nurse, or a certified nurse practitioner. This ensures that a qualified health professional has evaluated the employee's health status.
What should I do if I do not meet the immunization requirements?
If you do not meet the immunization requirements, you may need to obtain the necessary vaccinations or provide acceptable documentation of immunity. Consult with a healthcare provider to discuss your options.
Where can I obtain the Ohio JFS 01296 form?
The form can typically be obtained from the Ohio Department of Job and Family Services website or through your potential employer. It is important to ensure that you have the most current version of the form.
What happens if I fail to submit the form?
Failure to submit the form may result in your inability to work in a child care center or Type A home. Compliance with health requirements is essential for the safety and well-being of the children in care.