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The Lic 610A form, part of the California Department of Social Services' Community Care Licensing, is a critical document for family child care homes. This form serves as an Emergency Disaster Plan, outlining essential steps and resources to be utilized during various emergencies. It is important for caregivers to have a clear plan, as these provisions help ensure the safety and well-being of children in their care. The form details procedures for life-threatening emergencies, requiring the licensee to provide specific information such as contact details and addresses. Significantly, it includes a section dedicated to emergency contacts, featuring key local services like fire departments, hospitals, and child protective services. Effective evacuation procedures are highlighted, emphasizing the need for exit routes and safe gathering locations. In addition, it addresses the importance of relocation sites should the need arise. Utility shut-off information is also specified, ensuring that caregivers can react swiftly to emergencies that compromise home safety. Furthermore, identification of equipment locations aids in the rapid response to crises. By understanding these components, caregivers can maintain updated, accessible, and actionable emergency plans, thereby fostering an environment of safety and preparedness.

Lic 610A Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

EMERGENCY DISASTER PLAN FOR FAMILY CHILD CARE HOMES

Type or print clearly. Post next to phone. Keep current - Return a copy to the licensing office.

LICENSEE NAME:

DATE:

 

 

1.

EMERGENCIES - LIFE THREATENING - Call 9-1-1 - Tell them: Number Calling from:

 

 

 

 

 

HOME ADDRESS:

 

 

 

 

 

 

 

MAJOR CROSSROAD:

 

 

 

 

 

 

 

HOME DIRECTION FROM CROSSROAD:

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

EMERGENCY NAMES AND TELEPHONE NUMBERS (In addition to 9-1-1)

 

Fire/Paramedics:

 

Office of Emergency Services:

 

 

 

 

 

Red Cross:

Licensing:

Ambulance:

Other:

 

 

 

 

Hospital:

Police/Sheriff:

Child Protective Services:

 

 

 

 

 

 

 

 

Poison Control:

 

 

 

 

 

 

 

3.FACILITY EVACUATION - Some disasters require evacuation of the building. Using a copy of the Facility Sketch (LIC 999A), show arrows for the safest way to exit rooms. Be sure that exit doors are not locked from the inside. In the event of a fire, get everyone out, follow the escape routes, meet at a prearranged location, account for everyone, do not let anyone return to the building and call the fire department.

4.TEMPORARY RELOCATION SITE(S) - Some disasters require moving to a safe location. When relocating, determine whether you need food, water, blankets and flashlight and meet at a prearranged easily accessible location. Be sure to obtain permission from the property owner.

NAME:

PHONE:

 

 

ADDRESS:

 

 

 

NAME:

PHONE:

 

 

ADDRESS:

 

5.

UTILITY SHUT OFF -Indicate locations on the Facility Sketch (LIC 999A) with the exit routes.

GAS:

 

 

GAS CO. PHONE:

 

 

 

 

ELECTRIC:

 

ELECTRIC CO. PHONE:

 

 

 

 

WATER:

 

WATER CO. PHONE:

 

 

 

 

 

6.

EQUIPMENT LOCATION - The fire department may help you with installation information.

FIRE EXTINGUISHER LOCATION:

SMOKE DETECTOR LOCATION:

 

 

 

 

FIRE ALARM LOCATION ( IF YOU HAVE ONE):

 

 

TYPE

 

 

 

 

7.

OTHER EMERGENCY EQUIPMENT - Where appropriate identify location of first aid kit, blankets, food and water, flashlight, radio

 

and other emergency equipment.

 

 

 

LOCATION:

LIC 610A (6/05) PUBLIC

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

 

COMMUNITY CARE LICENSING

EMERGENCY DISASTER PLAN FOR FAMILY CHILD CARE HOMES

Need help filling out the Emergency Disaster Plan Form?

Applicants need to submit a plan to handle possible emergencies. The Emergency Disaster Plan is a plan that identifies resources when an emergency occurs. A copy of the form must be posted in a conspicuous place near a telephone and a copy given to the licensing agency with the application packet. Licensee is responsible for updating information as required and all information should be typed or clearly handwritten.

1.EMERGENCIES - LIFE THREATENING - Whenever a life threatening emergency occurs, use the 9-1-1 telephone number. Operators are able to speed dial help for any life threatening emergency. If the call is interrupted, they are usually able to identify the home address from the open line. It is important to write out exactly what needs to be said to direct help to the home. This means that you need to write out the home phone, the address of the home, the nearest major cross street and directions to the home from the cross street.

2.EMERGENCY NAMES AND TELEPHONE NUMBERS (In addition to 9-1-1) - This is a list of additional emergency resources that you may need. Most of the numbers are listed on the form. The Office of Emergency Services (OES) assists local government and the public with emergencies that threaten lives, property and the environment. The telephone number for your local OES can be found in the white pages of the telephone book under Government Listings, County Government Offices, “Emergency Operations”. It may also be found under County Sheriff’s Department. The “Other” is extra space for other numbers that you think may be needed in an emergency.

3.FACILITY EVACUATION - The most important action in a fire emergency is getting the children safely out and grouped together in a safe location. As part of your application packet, you need to complete a facility sketch. Take a copy of the sketch and identify the quickest exiting routes from each room. Copies of the exiting routes should be posted in conspicuous locations. You also need to identify a safe location where everyone should gather to be sure everyone is counted and no one remains in the building. You need to have regular fire drills with the children. Your fire department is an excellent resource for fire and evacuation instructions.

4.TEMPORARY RELOCATION SITES - In the event of an emergency or disaster, you need to make arrangements to move to a temporary site, such as at the home of a friend or a local church. You need to identify a second site in the event the first site is not immediately available in the emergency. Be sure to get permission from the property owner of the relocation site.

5.UTILITY SHUT OFF - In emergencies such as floods and earthquakes, it may be necessary to shut the utilities off. It is important to identify the locations of the utility shut off for such emergencies. You should also have a wrench on hand for the gas line. It also may be helpful to put the utility shut off locations on the Facility Sketch.

6.EQUIPMENT LOCATION - Your home must contain a fire extinguisher and smoke detector device which meet the standards established by the State Fire Marshal. The fire extinguisher must be in a location that is easily accessible and identified in this plan. The local fire department may help you with the location of fire equipment. In addition to smoke alarms, you need to identify and locate any other emergency alarms that are on the premises. If a fire is just beginning, it may be possible to extinguish the fire with a fire extinguisher. However, the children should be safely relocated before attempting to extinguish any fire.

7.OTHER EMERGENCY EQUIPMENT - In the event of a flood or earthquake, it may be necessary to have a first aid kit, blankets, food and water, radio, flashlight and other provisions. The plan needs to identify where this other emergency equipment is kept.

LIC 610A (6/05)

File Breakdown

Fact Name Details
Form Purpose This form serves as the Emergency Disaster Plan for family child care homes in California.
Reporting Requirement A copy of the completed form must be returned to the licensing office with the application packet.
Emergency Contact Information Licensees must list important emergency contacts, such as the police and fire services, in addition to 9-1-1.
Evacuation Procedures The form outlines steps for safely evacuating children during emergencies, emphasizing the need for posted escape routes.
Temporary Relocation Licensees are required to identify temporary relocation sites and obtain permission from the sites' property owners.
Utility Shutdown Locations of utility shut-offs must be indicated, and licensees are advised to have necessary tools for emergency situations.
Equipment Safety The form requires the identification of locations for safety equipment, including fire extinguishers and first aid kits.

Guide to Using Lic 610A

Filling out the Lic 610A form is essential for preparing an effective emergency disaster plan for family child care homes. This document helps ensure everyone's safety during emergencies by systematically detailing important information and resources. Follow these straightforward steps to complete the form accurately.

  1. Fill in your licensee name: Write your full name clearly at the top of the form under "LICENSEE NAME."
  2. Enter the date: Below your name, write today’s date in the format MM/DD/YYYY.
  3. Report life-threatening emergencies: Under section 1, provide your home address, a major crossroad near your location, and the direction from the crossroad to your home. Be prepared to call 9-1-1 in case of emergencies.
  4. List emergency contacts: In section 2, fill in important names and phone numbers of local services, including fire, police, hospitals, and other emergency resources.
  5. Create a facility evacuation plan: In section 3, use the Facility Sketch (LIC 999A) to illustrate exit routes and meeting points. Keep exit doors unlocked from the inside.
  6. Identify temporary relocation site(s): In section 4, name locations where you can safely relocate during an emergency. Include the property's address and phone number, ensuring you gain necessary permissions.
  7. Indicate utility shut-off locations: In section 5, provide information about where to access gas, electric, and water shut-offs. List the respective utility companies' names and phone numbers.
  8. Locate emergency equipment: In section 6, provide details on where fire extinguishers, smoke detectors, and any fire alarms are located in your home.
  9. Document other emergency supplies: In section 7, identify the locations of essential emergency items like first aid kits, food, water, and flashlights.

Once you have completed the form, ensure it is posted in a visible area close to a telephone. Keeping this information up-to-date is vital for ensuring everyone is prepared for any potential emergency. Remember, your proactive planning can make a significant difference in keeping children safe.

Get Answers on Lic 610A

What is the purpose of the Lic 610A form?

The Lic 610A form serves as an Emergency Disaster Plan specifically for Family Child Care Homes in California. Its primary purpose is to outline procedures and resources for managing emergencies that could threaten the safety of children in care. Completing this form helps ensure preparedness in case of disasters such as fires, earthquakes, or floods.

Who is responsible for maintaining the information on the Lic 610A form?

The licensee of the Family Child Care Home is responsible for maintaining the information on the Lic 610A form. This includes keeping contact numbers updated, refining evacuation routes, and modifying any emergency procedures as necessary. Regular reviews and updates are crucial to ensure the plan is current and effective.

Why is it important to post the Lic 610A form near a phone?

Posting the Lic 610A form near a phone ensures that all caregivers and visitors can easily access emergency information in a crisis. In high-stress situations, quick access to vital contact numbers and emergency procedures may be critical for the safety of children. Visibility enhances preparedness, reducing response time during emergencies.

What steps should be taken during a facility evacuation?

During a facility evacuation, follow these steps:

  1. Activate the fire alarm or emergency alert system if necessary.
  2. Guide all children to exit the building using marked escape routes outlined in the Facility Sketch.
  3. Gather at a prearranged safe location to ensure everyone is accounted for.
  4. Do not allow anyone to re-enter the building until given the all-clear by emergency services.
  5. Call 9-1-1 or the fire department if needed.

What should I include in the list of emergency names and telephone numbers?

The list of emergency names and telephone numbers should include:

  • Fire/Paramedics
  • Office of Emergency Services
  • Red Cross
  • Licensing agency
  • Ambulance services
  • Local hospital
  • Police/Sheriff
  • Child Protective Services
  • Poisons Control Center

Including local numbers and resources specific to your area can enhance the effectiveness of your plan.

What should I do if I need to relocate temporarily during an emergency?

If you need to relocate temporarily, identify one or two safe locations in advance, such as a neighbor’s home or a local community center. Ensure you have permission from the property owner to use these sites. Gather essential items such as food, water, and blankets if you need to move. Keep this information updated on the Lic 610A form.

How can I prepare for utility shut-off during emergencies?

Preparing for utility shut-off involves knowing the locations of your gas, electric, and water shut-off valves. It’s wise to have a wrench ready for the gas line and ensure that your utility shut-off instructions are marked on your Facility Sketch. This precaution is essential for safety during disasters like floods or earthquakes.

What types of emergency equipment should be identified in the plan?

The plan should identify the locations of essential emergency equipment, including:

  • Fire extinguishers
  • Smoke detectors
  • Fire alarms
  • First aid kits
  • Blankets
  • Food and water supplies
  • Flashlights and radios

Having this equipment readily available and easily locatable can save valuable time and lives in an emergency situation.

Common mistakes

Filling out the Lic 610A form can be overwhelming, and mistakes can happen easily. One common mistake is providing unclear contact information. It's essential to ensure that all phone numbers are accurate and easy to read. A tiny error, like a missed digit, can delay help in an emergency. Double-checking this section can save lives.

Another frequent error is not updating the information regularly. If your emergency contacts or relocation sites change, make sure to revise the form accordingly. An outdated contact list can create a chaotic situation when every second counts. Keeping this information current is critical for effective emergency planning.

Many people forget to include directions to their home from the nearest major crossroad. In a crisis, first responders need clear instructions. A well-defined path helps direct them promptly. Simplifying this information into a few easy-to-understand directions can make a real difference during an emergency.

Some individuals also overlook the importance of marking utility shut-off locations on the facility sketch. Knowing how to quickly shut off water, gas, and electricity can prevent further damage during a disaster. It’s easier for everyone involved if those spots are clearly indicated and easily accessible.

Another mistake involves the evacuation procedures. People often fail to practice these drills with the children regularly. The evacuation plan should be familiar to everyone. Performing drills helps ensure that everyone knows what to do in case of a real emergency.

Lastly, a typical oversight is neglecting to list all necessary emergency equipment. Essential items like first aid kits, flashlights, and food should be clearly identified on the form. Knowing where these supplies are located beforehand can greatly enhance safety and preparedness in any emergency scenario.

Documents used along the form

The Lic 610A form serves as an essential document for family child care homes, outlining an emergency disaster plan. Along with this form, several other documents and forms are commonly utilized to ensure a comprehensive emergency response. Here is a list of these important documents:

  • LIC 999A - Facility Sketch: This form depicts the layout of the facility, including exits and safe gathering areas for children during an emergency evacuation.
  • LIC 370 - Child Care Center Application: This application is submitted when seeking a license to operate a child care center, including information about staffing and facility details.
  • LIC 282 - Health and Safety Self-Assessment: Care providers complete this self-assessment to ensure compliance with health and safety standards in their facilities.
  • LIC 9186 - Personnel Record: This document contains the personal and professional information of staff members working within the child care home, ensuring compliance with background checks and training requirements.
  • LIC 613A - Emergency Contact Information: This form gathers contact information for parents or guardians of children in care, crucial for quick communication during emergencies.
  • LIC 9401 - CCL Complaint Form: Individuals use this form to report any complaints or incidents regarding care and safety within a child care facility.
  • First Aid Kit Inventory: A record of items included in the first aid kit, ensuring that caregivers have necessary supplies readily available during emergencies.
  • Equipment Maintenance Log: This log tracks the maintenance and inspection dates for emergency equipment, such as fire extinguishers and smoke detectors.
  • Emergency Drills Record: A documentation of emergency drills conducted at the facility to ensure that staff and children are familiar with evacuation procedures.

Collectively, these documents enhance the safety and preparedness of family child care homes. Having a well-rounded set of forms and plans is not only beneficial but essential in effectively managing emergencies.

Similar forms

  • Lic 999A - Facility Sketch: This document provides a visual representation of the layout of a facility. Similar to the Lic 610A, it emphasizes the importance of having clear exit routes and designated emergency locations.
  • LIC 321 - Child Care Center Application: This application requires detailed information about the child care facility. Like the Lic 610A, it necessitates planning for safety and emergencies in the child care setting.
  • LIC 282 - Facility Evaluation Report: This report assesses the compliance of a child care facility with regulations. It is similar in that it involves evaluating readiness for emergencies as outlined in the Lic 610A.
  • LIC 9100 - Application for a License to Operate a Family Child Care Home: This application form includes sections that ensure applicants are prepared for emergencies, paralleling the Lic 610A in terms of readiness and planning.
  • LIC 995 - Child Care Provider's Training Certificate: This certification confirms that a provider has received training in emergency procedures. The focus on emergency preparedness aligns closely with the goals of the Lic 610A.
  • LIC 996 - Emergency Disaster Plan for Child Care Centers: Specifically designed for child care centers, this document serves a similar purpose as the Lic 610A, guiding care providers on how to prepare for emergencies.
  • LIC 9050 - Administrator's Acknowledgment of Responsibilities: This form informs administrators of their obligations, which includes maintaining a safe environment, akin to the responsibilities outlined in the Lic 610A regarding emergency preparedness.

Dos and Don'ts

When filling out the Lic 610A form, it's essential to follow specific guidelines to ensure accuracy and compliance. Here are some things you should and shouldn't do:

  • Do type or print your information clearly. This ensures that your form is easy to read and process.
  • Do provide complete emergency contact information. List all necessary emergency numbers and resources, including local fire and police departments.
  • Do regularly update your emergency plan. Life and circumstances change, so keeping your plan current is crucial for safety.
  • Do post the completed form in a visible location. Make it easy for caregivers and others to find in case of an emergency.
  • Do keep copies of the form for your records. Having an accessible backup can be helpful during emergencies.
  • Don’t leave out crucial details. Omitting information can lead to confusion during a crisis.
  • Don’t forget to practice your evacuation plan. Regular drills help ensure everyone knows what to do when danger arises.

Misconceptions

Understanding the Lic 610A form is essential for family child care providers in California, yet there are several common misconceptions about it. Clearing up these misunderstandings can help ensure compliance with regulations while prioritizing the safety of children in care.

  • Misconception 1: The Lic 610A form is optional.
  • This is not true. The Lic 610A form, also known as the Emergency Disaster Plan, is a required document that must be submitted to the licensing agency. It helps ensure that providers have a clear plan to handle emergencies, protecting both children and staff.

  • Misconception 2: Once filled out, the form does not need updates.
  • Many people think that the Emergencies Disaster Plan can be set and forgotten. In reality, this form must be kept current. Licensees are responsible for regularly updating the information to reflect any changes in contact details, emergency resources, or evacuation plans.

  • Misconception 3: You only need to use the form in a disaster.
  • This is a misunderstanding. The Lic 610A form should be referred to even in minor emergencies. It's a valuable resource to ensure that all necessary steps are taken to keep everyone safe, not just in severe situations.

  • Misconception 4: Only the licensee needs to understand the plan.
  • It's a common belief that just the person in charge should know the details. However, everyone working in the facility must be familiar with the plan. Regular drills and training sessions can ensure that all staff members are prepared to act quickly and effectively.

  • Misconception 5: The form can be placed anywhere in the facility.
  • Another misconception is about the placement of the Lic 610A form. It is critical to post the form in a conspicuous location near a telephone for easy access during emergencies. This ensures that anyone in the facility can quickly find and refer to the emergency plan when required.

Key takeaways

When filling out and using the Lic 610A form, consider these key takeaways:

  • Thorough Completion is Essential: Fill out the form completely and legibly. Use clear printing or typing to ensure readability and avoid confusion during an emergency.
  • Emergency Contact Information: Keep an updated list of emergency numbers readily available. This includes local fire, police, and hospitals, in addition to the essential 9-1-1 contacts.
  • Facility Evacuation Plans: Develop clear evacuation routes and designated safe areas for children. Regularly practice evacuation drills to ensure everyone knows the plan.
  • Temporary Relocation Sites: Identify safe locations ahead of time for emergencies. Make sure to obtain permission from the owners of these sites.
  • Utility Shut-Off Information: Clearly indicate where the utility shut-off locations are on the facility sketch. This information is crucial during emergencies like floods or earthquakes.

Remember, the effectiveness of the Emergency Disaster Plan relies on proper preparation and regular updates.