What is the Ohio JFS 01296 form?
The Ohio JFS 01296 form is an Employee Medical Statement required for individuals seeking employment in child care centers and Type A homes. This form ensures that employees meet health standards set by the Ohio Administrative Code.
Who needs to complete the JFS 01296 form?
Any employee who will work in a child care center or a Type A home in Ohio must complete this form. It is essential for ensuring that all staff members are physically fit to care for children.
When must the JFS 01296 form be completed?
The form must be completed no more than 12 months prior to the employee's first day of work. This time frame ensures that the health information is current and relevant.
What health requirements are included in the JFS 01296 form?
The form requires verification of the employee's physical fitness for work, as well as proof of immunizations against Diphtheria/Tetanus/Pertussis (Tdap) and Measles, Mumps, and Rubella (MMR). Specific exceptions apply for individuals born on or before December 31, 1956, regarding MMR vaccination.
Who can sign the JFS 01296 form?
The form must be signed by a licensed physician, a physician's assistant, an advanced practice nurse, or a certified nurse practitioner. This ensures that a qualified health professional has assessed the employee's health status.
What happens if an employee does not submit the JFS 01296 form?
Failure to submit the JFS 01296 form can result in the inability to work in a child care setting. Compliance with this requirement is crucial for maintaining licensing standards.
Is there a specific format for the information provided on the JFS 01296 form?
Yes, the form requires specific details such as the employee's name, home address, first day of employment, and the health care provider's information. This structured format helps ensure all necessary information is collected efficiently.
Can the JFS 01296 form be submitted electronically?
The submission process may vary by employer. It is advisable to check with the specific child care center or Type A home regarding their preferred method of submission, whether electronic or paper format.
What should I do if I have questions about filling out the JFS 01296 form?
If you have questions, it is best to consult with your health care provider or the administrative staff at your child care facility. They can provide guidance on completing the form accurately.
Where can I find the JFS 01296 form?
The JFS 01296 form can typically be found on the Ohio Department of Job and Family Services website or through your child care center's administrative office. Ensure you are using the most current version of the form.