CD 322 is Pennsylvania’s Child Care Staff Health Assessment form. Get the PDF directly from the Department of Human Services. The official download is free and does not require a Daycare Compliance account.
Open the official CD 322 PDF ↗
Source: Pennsylvania DHS child care forms library. If the direct PDF moves, select “CD 322: Child Care Staff Health Assessment” in that library. CD 51 is the separate child health assessment form.
Who fills out CD 322?
The form separates employer information about the person’s work activities from the clinical assessment. A physician, physician’s assistant, or certified registered nurse practitioner completes the clinical section. The PDF includes signature, date, title, and contact fields, along with tuberculosis-testing information. Follow the official form’s instructions and the clinician’s direction.
Is the staff health assessment required every year?
For the people covered by Pennsylvania’s center rule, 55 Pa. Code § 3270.151 specifies an assessment within 12 months before initial service and every 24 months afterward. Its validity provision measures 24 months from the signature date, subject to health-related conditions. It also describes role-specific circumstances and exceptions.
That does not establish a blanket annual deadline for every worker. This timing summary concerns child care centers. Group and family homes should check their own chapters through the DHS regulations page. Confirm uncertain cases with the licensing office.
What date should go in the records tracker?
Keep the signed assessment date, the next date you have confirmed applies, and your internal follow-up date in separate fields. The day someone emails the document to you is a receipt date; it should not silently replace the date on the signed record.
| Tracking field | Purpose |
|---|---|
| Assessment signature date | Record the date from the signed document. |
| Confirmed next date | Record the deadline you verified for this person and program. |
| Follow-up date | Choose when to request or check progress on the next assessment. |
| Document reference | Point authorized staff to the restricted personnel record. |
Receiving and filing the completed assessment
- Match the returned document to the intended staff record.
- Check that the relevant sections, signature, title, and date are present. Direct clinical questions to the clinician.
- Record any missing item as a specific follow-up task.
- Store the completed assessment with appropriate access restrictions. Keep diagnoses and test results out of a shared task list.
- Update your index only after reviewing the actual record.
A reminder or a “document present” label describes your recordkeeping status. It does not make a medical assessment or determine a person’s fitness for work.
Connect it to the rest of the personnel file
Use the Pennsylvania daycare staff-file checklist for the complete organizing workflow, and the blank records tracker for an index you can use with existing folders.
If you want private document requests and reminders for dates you confirm, see the staff records workspace. You can start a no-card trial with one staff record.