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Health and Medical Supervision

Medical officer of health recommendations, inspections

Any recommendation or instruction made by a medical officer of health with respect to the health or well-being of a child receiving care must be carried out by staff in a child care centre and recorded in the daily written record.

For example, child care centres must comply with local public health requirements for hand washing, sanitation, food storage and preparation.

A copy of any report made by the local medical officer of health or the local fire department must be kept on the premises of the child care centre. Another copy must be sent immediately to ministry staff.

Food storage on shelves


Section 32 of Ontario Regulation 137/15 - General


Recommendations related to health and safety help to ensure children overall well-being, which includes physical and mental health and well-being.

Taking measures to protect children’s health in all areas can have lifelong impacts. Being responsive to children’s varied physical and emotional states helps children feel safe and secure. Helping children to recognize their varied physiological, biological, emotional states and rhythms supports their developing self-regulation abilities.

Interaction with children and their natural environment, including open-ended materials, allow children to deepen their exploration and make meaning of the world around them.

Sleep Policies and Supervision

Every licensee shall ensure that a child who is younger than 12 months is placed for sleep in a manner that is consistent with the recommendations set out in the document entitled “Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada” published by Public Health Agency of Canada, unless the child’s physician recommends otherwise in writing.

Every licensee shall ensure that, if child care is provided for a child who regularly sleeps at a child care centre or at a premises where it oversees the provision of home child care:

  • Direct visual checks are performed periodically on each sleeping child by being physically present beside the child and looking for indicators of distress or unusual behaviour
  • There is sufficient light in the sleep area or room to conduct direct visual checks
  • There are written policies and procedures with respect to sleep, and the policies and procedures,
    • Provide that children will be assigned to individual cribs or cots in accordance with Ontario Regulation 137/15
    • Provide that parents will be consulted respecting a child’s sleeping arrangements at the time the child is enrolled and at any other appropriate time
    • Provide that parents of children younger than 12 months will be advised of the licensee’s obligation under subsection (1)
    • Provide that parents of children who regularly sleep at the child care will be advised of the centre’s or agency’s policies and procedures regarding children’s sleep
    • Provide that the observance of any significant changes in a child’s sleeping patterns during sleep will be communicated to parents and will result in adjustments to the way the child is supervised during sleep
    • Include details regarding the performance of direct visual checks, including how frequently direct visual checks will be performed and how direct visual checks will be documented. With respect of children enrolled in home child care, the licensee shall consider parents’ input, the sleep environment and the proximity of the sleeping area to the child care provider

Every licensee shall ensure that, in each child care centre that has a separate area or room for sleeping, there is a system in place to immediately identify which children are present in the area or room.

Electronic sleep monitoring equipment must be,

  • able to detect and monitor the sounds, and if applicable, video images of every sleeping child
  • actively monitored by employees
  • checked daily to ensure proper functioning
  • used to detect and monitor sounds and they are not used as a replacement for the required direct visual checks


Sections 33 of Ontario Regulation 137/15 - General


In order to nurture children’s healthy development and well-being it is important to find ways to support each child’s varied physiological and biological rhythms and needs for active play as well as rest and quiet time. Consider:

  • How can your program support children’s varied physiological and biological rhythms?
  • How can your program provide a flexible context that respects children’s choices and needs?


Keep a first-aid manual and first-aid kit in an easily accessible location. All staff should be aware of the location. Check contents of the first-aid kit regularly to replenish it or replace out of date products.

Countertop with first aid kit highlighted


Monthly First Aid Kit Inspection


Section 34 of Ontario Regulation 137/15 - General


Each child must be immunized as recommended by a local medical officer of health, unless exempted based upon the parent’s religious/conscience grounds or a medical reason, as set out by a doctor. A record of the required immunizations, or objection/exemption, must be kept in each child’s file. Objections and medical reasons shall be submitted in a form approved by the Minister. Exemptions made before August 29, 2016 shall expire on September 1, 2017 unless a new objection or medical reasons are submitted in a form approved by the Minister before that date.

(Note: The licensee does not need a record of immunization if the child is attending a school or private school within the meaning of the Education Act.)


Statement of Medical Exemption

Statement of Conscience or Religious Belief

Filing cabinet with drawer labelled children’s records highlighted


Section 35 of Ontario Regulation 137/15 - General

Child illness and accident

Upon arrival, staff must make a daily observation of each child to look for any signs of illness. When a child appears to be ill, the child must be separated from other children. Symptoms of the illness must be noted in the child’s records.

When a child is separated from other children because of suspected illness, a parent must be contacted to take the child home as soon as possible.

If it is not possible for a parent of the child to take the child home or if the child needs immediate medical attention, the child must be examined by a qualified physician or nurse.

When a child is injured, an accident report must be made that describes the injury and any first aid provided. A copy of the report must be given to a parent of the child.


Section 36 of Ontario Regulation 137/15 - General


Observing the children and how they are doing supports their well-being and helps to ensure that measures are in place to act in cases where their well-being is compromised.

It is important to communicate with parents about what their children are experiencing throughout the day, including their physical, emotional, and mental health.

Daily Written Record 

A daily written record must be kept. It should include a summary of any incident(s) affecting the health, safety and well-being of staff or an enrolled child. It must be kept for at least three years. If the incident affects a child, a parent must be notified.

Daily written record book highlighted on top of a bookshelf


Section 37 of Ontario Regulation 137/15 - General


The daily written record can also be used to document and help inform educator’s understanding of children’s learning and interpretation.

The daily written record can be a means for learning about how children think and learn. Documenting what children experience throughout the day can support educators to be co-learners alongside children and their families.

Serious Occurrences

Licensees are required to report serious occurrences in the Child Care Licensing System within 24 hours of becoming aware of the incident. The 24-hour window to report a serious occurrence begins as soon as the licensee, delegate, or supervisor becomes aware of the incident. Serious occurrence reports can be submitted or updated by site or agency delegates (supervisors and home visitors) where the licensee has chosen to enrol them in the system. A Serious Occurrence Notification Form must be posted on-site about a serious occurrence that happened at the child care location for at least 10 business days. The notification form must be kept in a secure location for at least three years from the date it is made.

Licensees must have written policies and procedures regarding serious occurrences that address, at a minimum, how to identify, respond to and report a serious occurrence.

Licensees are required to conduct an annual analysis of all serious occurrences that occurred in the previous year, document the actions taken in response to the analysis, and keep a record of this analysis.


Section 38 of Ontario Regulation 137/15 - General


Reporting serious incidents involving children supports communication between child care centre staff, the Ministry of Education, and parents to help ensure the well-being of all children.

Anaphylactic Policy

Every licensee shall ensure that each child care centre and each premises where it oversees the provision of home child care has an anaphylactic policy that includes the following:

  • a strategy to reduce the risk of exposure to anaphylactic causative agents
  • a communication plan for the provision of information on life-threatening allergies, including anaphylactic allergies
  • development of an individualized plan for each child with an anaphylactic allergy who, receives child care at a child care centre, or is enrolled with a home child care agency and receives care at the premises
  • training on procedures to be followed if a child has an anaphylactic reaction.

The individualized plan shall be developed in consultation with a parent of the child and with any regulated health professional who is involved in the child’s health care and who, in the parents’ opinion should be involved in the consultation. The individualized plan shall include a description of the procedures to be followed in the event of an allergic reaction or other medical emergency.

Epinephrine auto-injector administration training may be provided by:

  • a physician;
  • a parent;
  • a designate of the local medical officer of health;
  • a certified epinephrine auto-injector instructor/trainer; or,
  • other agencies that may provide training.

The licensee should retain a list of the date(s) of training for each staff to demonstrate that each person has received the training before the start of employment.

For child care centres that have enrolled children with life-threatening allergies, an individualized plan must be developed for each child that includes emergency procedures for the child. It must be reviewed:

  • by all employees before they begin their employment and at least annually afterwards;
  • by volunteers and students before they begin providing that care or guidance and at least annually afterwards.

Countertop with lists of allergies highlighted


Section 39 of Ontario Regulation 137/15 - General


Consider ways to ensure strong communication with families to support children’s well-being, such as working together with parents to develop a plan that supports the health and safety of children who have life-threatening allergies.

Administration of Drugs and Medications

Medication can only be administered to a child where a parent provides written consent with a schedule that sets out the times the drug or medication is to be given and amounts to be administered, in accordance with a medication administration policy developed and implemented by the licensee.

Medication brought by parents for their child must be kept in a locked container in the room and inaccessible to children at all times. Medication that needs refrigeration must be kept in a locked box in a refrigerator.

Medication can be administered to a child only from the original container or package which is labelled with:

  • the child's name
  • the name of the drug or medication
  • the dosage of the drug or medication
  • the date of purchase and if applicable, expiration
  • instructions for storage and administration

One person must be in charge of all medications. Medications are dealt with by that person or his/her designate in accordance with written procedures.


Section 40 of Ontario Regulation 137/15 - General


Medication Administration Log