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Our names:
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Our home
address:
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Our home
telephone number:
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The name,
phone number, and location of where we'll be:
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The time we
plan to return home:
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House key is
kept:
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Car key is
kept:
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First-aid
supplies are kept:
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Medications
are kept:
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When to
contact us:
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If a child
has been crying for more than 20 or 30 minutes and you can't figure out
what's wrong.
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If a child
develops a fever, vomits, or is injured (more than a superficial scrape).
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Anytime a
situation develops that you feel you can't handle without help.
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Mom's work
and/or cell phone numbers:
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Dad's work
and/or cell phone numbers:
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In an
emergency, if we can't be reached, here's who to contact:
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(Input name,
relationship, address, and telephone)
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(Input name,
relationship, address, and telephone)
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(Input name,
relationship, address, and telephone)
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Emergency
help numbers to call:
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Poison
control:
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Police
department:
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Fire
department:
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Hospital or
urgent care:
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Pediatrician's name and number:
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What to do
in case of a fire:
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In the case
of a small, contained fire (on the stove, for example), the fire
extinguisher can be used if you already know how to operate one. Our fire
extinguisher is located:
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In the event
of a larger fire, gather all the children immediately and usher them out of
the house via the nearest door or window.
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Test doors
before you open them. Kneel down, reach up as high as you can, and touch the
door with the back of your hand--at the knob and around the frame. If
there's a fire on the other side, it will feel warm on the knob and around
the cracks.
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If the door
is warm, try another escape route.
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Exits are
located:
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Take the kids
and go straight to a neighbor's house--preferably one who is on the "in case
of emergency" list--and call 911 from there.
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Call us, or
one of the above alternate contacts if we are not reachable.
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Health
insurance information you may need:
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Insurance
company:
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Group/policy
number:
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Policy
holder's name:
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Policy
holder's identification number:
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Details
about our children:
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(Input
child's full name, age, weight, height, nap and/or bed times, plus special
instructions--food allergies, medical condition(s), names of medication(s)
and dosages, special instructions)
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(Input
child's full name, age, weight, height, nap and/or bed times, plus special
instructions--food allergies, medical condition(s), names of medication(s)
and dosages, special instructions)
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(Input
child's full name, age, weight, height, nap and/or bed times, plus special
instructions--food allergies, medical condition(s), names of medication(s)
and dosages, special instructions)
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(Input
child's full name, age, weight, height, nap and/or bed times, plus special
instructions--food allergies, medical condition(s), names of medication(s)
and dosages, special instructions)
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(Input
child's full name, age, weight, height, nap and/or bed times, plus special
instructions--food allergies, medical condition(s), names of medication(s)
and dosages, special instructions)
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House rules
and routines:
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Television
programs and movies that are acceptable or unacceptable:
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Foods that
are acceptable or unacceptable:
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Guidelines
for outside play:
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Guidelines
for company:
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Bedtime
routine:
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Special
considerations:
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Our
discipline philosophy:
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Never leave
children unattended with food.
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Special
requests:
Please write down details about your day/night with our children.
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What and when
did they eat?
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What time did
they nap/go to bed for the night?
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Were they
well-behaved?
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Follow
general safety rules:
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Avoid giving:
raisins, hot dogs, raw carrots, celery, grapes, nuts, hard candy, gum,
popcorn, raw pears and apples to children under age four years. For ages
four to six years, be sure to peel and cut apples, pears, and carrots.
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Never drink
or eat anything hot while holding a baby or young child.
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Never leave a
child unattended with food. Make sure any food given to children under age
four years is cut into tiny pieces (about the size of a fingertip).
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Install
child-resistant covers on all electrical outlets.
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Keep dangerous
chemicals out of children's reach.
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For strings
and ribbons, follow the six-inch rule.
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Always use a
safety belt on your baby when she is sitting in a bouncy seat or a swing.
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Shorten
curtain and blind cords.
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Place
furniture well away from windows.
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Use corner
bumpers on furniture and fireplace-hearth edges.
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Place
houseplants out of children's reach.
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Know the names
of all plants in case a child eats one of them.
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Keep
cigarettes, matches, and lighters out of children's reach.
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Safeguard
heating and gas systems against accidents.
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Be sure that
furnaces, fireplaces, wood-burning stoves, space heaters, and gas appliances
are vented properly.
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Place screened
barriers around fireplaces, radiators, and portable space heaters.
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Install
carbon-monoxide (CO) alarms outside bedrooms to help prevent CO poisoning.
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Install smoke
alarms outside each bedroom and on every level of your home.
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Remove the
plastic end caps on doorstops or replace the stops with a one-piece design
to prevent choking.
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Consider
placing plastic guards along the hinge side of frequently used interior
doors to prevent the doors from pinching fingers.
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Safety-proof
windows and fire exits.
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Make a fire
evacuation plan and practice fire escape routes at least twice a year.
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Keep firearms
and ammunition safely locked away.
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Secure
unsteady furnishings.
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Avoid
household water hazards.
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Test homes
built before 1978 for lead paint.
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Learn first
aid and CPR.
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Hallways and staircases:
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Avoid dark
hallways and rugs that slip.
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Safety-proof
stairs.
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If possible,
install carpeting on stairways to protect from falls.
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Kids' rooms:
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Position your
child's crib away from all drapery, electrical cords, and windows.
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Make sure the
crib meets national safety standards.
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Make sure the
mattress fits snugly.
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Be sure the
crib sheet fits snugly.
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If you use a
crib bumper, make sure it's firm (not fluffy) and secured tightly with at
least six ties.
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Remove mobiles
and other hanging toys from the crib as soon as your child can reach up and
touch them.
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Place infants
under one year on their backs to sleep.
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Never use an
electric blanket in the bed or crib of a small child or infant.
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Place
night-lights at least three feet away from the crib, bedding, and draperies
to prevent fires.
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Always use a
safety belt on your infant when you have her on a changing table, and never
leave her unattended.
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Provide
padding for falls.
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Check age
labels for appropriate toys.
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Be vigilant
about choking hazards.
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Use side
railings for children just getting used to "big kid" beds.
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If bedrooms
are on second or third stories, be sure to have a fire-escape ladder in each
room.
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Bathroom:
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Put a lock on
the medicine cabinet.
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To prevent
poisoning, lock away all vitamins and medicines.
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Install
toilet-lid locks to prevent drowning.
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Lower the
household water temperature.
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Always test
the water first before bathing a child.
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Make sure
bathtubs and showers aren't slippery.
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Use electrical
appliances carefully.
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Install
ground-fault circuit interrupters on outlets near sinks and bathtubs.
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Never leave a
young child alone in the bathroom.
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Kitchen:
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Keep knives,
cleaning supplies, and plastic bags out of children's reach.
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To avoid fires
and burns, never leave cooking food unattended.
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If stove knobs
are easily accessible to children, use protective covers to prevent kids
from turning them.
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Teach your
kids how to respond to fire.
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When they're
not in use, unplug electrical appliances.
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Replace any
frayed cords and wires.
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Keep chairs
and step stools away from counters and the stove.
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Keep activated
charcoal (helps absorb some poisons) and syrup of ipecac (used to induce
vomiting) on hand.
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Beware of
foods that children can choke on.
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Yard:
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Store tools,
garden, and lawn-care equipment and supplies in a locked closet or shed.
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Don't use a
power mower to cut the lawn when young children are around.
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Don't allow
children to play on a treated lawn for at least 48 hours following an
application of a fertilizer or a pesticide.
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Know the types
of trees on the property in the event children ingest berries, leaves, or
other plant life.
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If you have a
swimming pool, install a fence (with an automatic childproof gate) that
separates the house from the pool.
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When you
barbecue outdoors, never leave kids unattended around the grill.
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Store propane
grills where children cannot reach the knobs.
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Other resources for childproofing your home:
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To find outlet
covers, cord shorteners, cabinet latches, and toilet-lid locks, check with
your local hardware store.
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For
consumer-product and home-safety information, contact the U.S. Consumer
Product Safety Commission.
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For details
about child and home safety, contact the National Safe Kids Campaign.
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For
information about child lead poisoning, read the "Lead Hazard Information"
pamphlet from the department of Housing and Urban Development.
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For
information about safe drinking water, contact the Environmental Protection
Agency's Office of Water.
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To
make sure that your home is a safe haven for your children - and you - learn
to spot and eliminate hazards throughout the house. This checklist will show
you how. Register
with ClubMom to customize this checklist by assigning due dates, adding
new tasks, scheduling email reminders, and more.