CHILD CARE HEALTH CONSULTANT AGREEMENT
DCYF 15-966 (REV. 10/2019) EXT Page 1 of 2
Child Care Health Consultant Agreement
This consultation agreement is between:
Early Learning Program Enter Name
Enter Contact Name
Enter Street Address
Enter City, State, Zip
Enter Phone
Enter Email
and
Child Care Health Consultant Enter Contact Name
Enter Street Address
Enter City, State, Zip
Enter Phone
Enter Email
Agreement:
Under this agreement, the child care health consultant will:
• Conduct at least one on-site visit monthly, if an infant is enrolled, during which the consultant:
- Observes and assesses staff knowledge of infant health, development, and safety and offers
support through training, consultation or referral;
- Observes and assesses classroom health practices including, but not limited to, infection
control, including cleaning, sanitizing, and disinfecting, and provides technical assistance to
correct any practices of concern;
- Observes and assesses behavior, development, and health status of individual infants in care
and makes recommendations to staff or parents or guardians including if further assessment is
recommended, as requested or otherwise determined appropriate.
Pursuant to Washington Administrative Code (WAC) 110-300-0275, a center early learning provider
licensed to care for any infant must employ or contract with a child care health consultant to
provide health consultation to support the practices of staff working with infants and to support the
needs of individual infants. A center early learning provider must enter into a department approved
written agreement for services with a child care health consultant.
CHILD CARE HEALTH CONSULTANT AGREEMENT
DCYF 15-966 (REV. 10/2019) EXT Page 2 of 2
• Provide a dated, signed written summary to the early learning provider for each visit that includes
topics discussed with parents or staff, any areas of concern related to discussion, observation,
assessment, or screening outcomes.
• Report each visit to the Department of Children, Youth, and Families (DCYF).
• Be available, or make available a designee who meets the same requirements of the child care
health consultant as outlined below, by phone as needed.
Signatures:
_______________________________________________ _____________________________
Early Learning Provider Date
_______________________________________________ _____________________________
Child Care Health Consultant Date
The child care health consultant must be a currently licensed registered nurse who:
• Has worked in pediatrics or public health in the past five years or has taken or
taught classes in pediatric nursing at the college level in the past five years;
• Has experience with state licensing and public health requirements; and
• Has knowledge and experience sufficient to provide service consistent with the
health consultant competencies described in the most current version of Caring
for Our Children.
I declare that I am qualified to serve as a child care health consultant based on the
requirements outlined above.
______________________________________________ _______________
Child Care Health Consultant Signature Date
