Below are a series of sample forms and documents that will make it easier to comply with the requirements of the rules for operating a program, enrolling children, and employing child care staff. The last section contains helpful information regarding such topics as immunization, weather conditions, and illnesses; it also contains resources that may be helpful in providing quality child care, including contacts with other agencies and services in the state if Maine or on the national level.
Disclaimer: The forms and documents made available on this site will meet the minimum requirements established in rule, if they are adopted as drafted. Providers may choose to expand the content to meet the needs of their services and are encouraged to personalize them by adding program names, logos, and/or policies and procedures. Otherwise deleting and/or altering the content of these forms may have the result that they are no longer compliant with the rules.
Sample Program Forms
- Sample Employee Handbook Outline (PDF) (also available in Word)
- Sample Fire Evacuation Drill Log (PDF) (also available in Word)
- Sample Health Care Consultant Agreement (PDF) (also available in Word)
- Sample Provider (Parent) Handbook Outline (PDF) (also available in Word)
- Sample Permission Form (PDF) (also available in Word)
- Sample Play Area Inspection Form (PDF) (also available in Word)
- Sample Swimming Pool Safety Checklist (PDF) (also available in Word)
- Waiver Request Form (PDF) (also available in Word)
- Sample Weekly Attendance Monday through Friday (PDF) (also available in Word)
- Sample Weekly Attendance Sunday through Saturday (PDF) (also available in Word)
- YIKES Planning Guide 2015 (PDF) (also available in Word)
- YIKES Emergency Response Plan (PDF) (also available in Word)
Sample Child Record Forms
- Sample Child Care Contract (PDF) (also available in Word)
- Sample Child Record Review Form (PDF) (also available in Excel)
- Sample Child Enrollment Form (PDF) (also available in Word)
- Sample Child Record Annual Update Verification Form (PDF) (also available in Word)
- Sample Emergency Medical Treatment Release (PDF) (also available in Word)
- Sample Accident Report Version 1 (PDF) (also available in Word)
- Sample Accident Report Version 2 (PDF) (also available in Word)
- Sample Behavior Incident Report (PDF) (also available in Word)
- Sample Medication Administration Permission Form and Medication Administration Record (PDF) (also available in Word)
- Notifiable Conditions Reporting Form (PDF) (also available in Word)
- Sample Mandated Reporter Worksheet (PDF) (also available in Word)
- Maine AAP Childcare Medical Exemption Form (PDF)
Sample Child Care Staff Member Forms
- Nursery School Medical Statement (PDF) (also available in Word)
- Sample Orientation Checklist for Child Care Centers (PDF) (also available in Word)
- Sample Expanded Orientation Checklist (PDF) (also available in Word)
- Sample Personnel Evaluation Form (PDF) (also available in Word)
- Sample Family Child Care Personnel Record Form (PDF) (also available in Word)
- Sample Child Care Facility Personnel Record Review (PDF) (also available in Excel)
- Sample Training Log (PDF) (also available in Word)
Information and Resources
- Information on the Child Care Background Check Process
- Maine Roads to Quality Professional Development Network for Child Care Providers (PDF) (providing technical assistance and training to providers)
- Wading and Swimming Matrix (PDF) (also available in Word)
- Child Care Licensing Immunization Standards (PDF) (also available in Word)
- Child Care Licensing Links (PDF) (also available in Word)
- Contact List (PDF) (also available in Word)
- FAQs (PDF) (also available in Word)
- Arabic (PDF) (also available in Word)
- French (PDF) (also available in Word)
- Kinyarwanda (PDF) (also available in Word)
- Lingala (PDF) (also available in Word)
- Portuguese (PDF) (also available in Word)
- Spanish (PDF) (also available in Word)
- Swahili (PDF) (also available in Word)
- Lead Safe Child Care (PDF) (also available in Word)
- Notifiable Conditions List: Illnesses that must be reported to the Maine CDC (PDF)
- Child Care Weather Watch (PDF)
- Air Quality Index