CD 322 - Child Care Staff Health Assessment
CHILD CARE STAFF HEALTH ASSESSMENT (55 Pa. Code ยงยง3270.151, 3280.151 and 3290.151) NAME OF PERSON EXAMINED (Please print) REASON FOR EXAMINATION Initial employment in child care Biennial re-examination THIS SECTION TO BE COMPLETED BY EMPLOYER This physical examination is for the purpose of employment in a child care facility. ................
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