OCFS-4880 (5/2014) FRONT Page 1

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

INDIVIDUAL TRAINING TRACKING FORM FOR CHILD DAY CARE PERSONNEL

Caregiver Name:	Role:
Full Time Part Time Hours	License/Registration Period
Director/Provider:	Start:	/ /	Midpoint:	/ /	Expiration:	/ /
Program Name:	License/Registration Number:	Individual’s Start Date:	/ /

TITLE OF TRAINING	SPONSORING ORGANIZATION/TRAINER (CCR&R, RED CROSS, SUNY, ETC)	TYPE OF TRAINING (VIDEO, CLASSROOM, COLLEGE, TELECON-FERENCE ETC)	DATE OF TRAINING	TOTAL HOURS	(1) Principles of
Childhood Development	(2) Nutrition & Health
Needs of Infants
& Children	(3) Child Day Care
Program Development	(4) Safety & Security

Procedures	(5) Business Record Maintenance

& Management	(6) Child Abuse & Maltreatment Identification & Prevention	(7) Statutes & Regulations

Pertaining to Child Day Care	(8) Statutes & Regulations

Pertaining to Child Abuse
& Maltreatment	(9) Education and Information

on the Identification, Diagnosis

& Prevention of Shaken Baby Syndrome
/ /
/ /
/ /
/ /
/ /
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/ /
/ /
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TOTAL FOR PAGE 1:

OCFS-4880 (5/2014)	REVERSE Page 2

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

INDIVIDUAL TRAINING TRACKING FORM FOR CHILD DAY CARE PERSONNEL

TITLE OF TRAINING	SPONSORING ORGANIZATION/TRAINER (CCR&R, RED CROSS, SUNY, ETC)	TYPE OF TRAINING (VIDEO, CLASSROOM, COLLEGE, TELECON-FERENCE ETC)	DATE OF TRAINING	TOTAL HOURS	(1) Principles of
Childhood Development	(2) Nutrition & Health
Needs of Infants
& Children	(3) Child Day Care
Program Development	(4) Safety & Security

Procedures	(5) Business Record Maintenance

& Management	(6) Child Abuse & Maltreatment Identification & Prevention	(7) Statutes & Regulations

Pertaining to Child Day Care	(8) Statutes & Regulations

Pertaining to Child Abuse
& Maltreatment	(9) Education and Information

on the Identification, Diagnosis

& Prevention of Shaken Baby Syndrome
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
TOTAL FOR PAGE 2:
GRAND TOTALS:

Director/Provider Signature:
Title:	Date:	/ /
Caregiver Signature:
Role:	Date:	/ /
A copy of this form and valid documentation of training hours must be kept in employee personnel files and must be available for review by OCFS when requested. This form (when signed and dated) may be used to transfer training hours between day care programs.

2015-01-05