2022 Edition

Early Childhood Education (CA-ECE) 5: Health and Safety

The organization promotes and protects the health and safety of children and staff.




Early Childhood Education facilitates appropriate child development and ensures the health and safety of children in care.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures for reporting, responding to and recording health problems and accidents
  • Classroom cleaning and sanitation procedures
  • Diaper changing procedures
  • Hand washing procedures
  • Child abuse and neglect reporting procedures
  • Procedures for notifying teachers of children with medical needs in their care
  • Bottle handling procedures
  • Infant sleep procedures
  • Smoking policy
  • Procedure for staying up-to-date on product recalls
  • Health policy/procedures provided to parents
  • Menus for meals and snacks for the previous six months
  • Copies of daily schedules from each classroom indicating time for active play
  • Evidence of collaboration with a medical provider
  • Documentation of professional installation, maintenance, and annual inspection of playground equipment from the previous 12 months
  • Documentation of monthly playground maintenance inspections for the previous six months
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Parents
  • Review personnel files for:
    1. documentation of health screening
    2. CPR and First Aid certification
  • Review children's health records
  • Observe facility

Fundamental Practice

CA-ECE 5.01

All parents receive a written health policy and procedures that address:
  1. the process for determining whether or not the organization can handle a child’s specific health needs;
  2. attendance guidelines for sick children including separation from other children; and
  3. procedures for notifying parents that their child may have been exposed to an infectious disease.

Fundamental Practice

CA-ECE 5.02

Child health problems and accidents, including changes in appearance or behaviour, are promptly recorded and reported to parents and administration, and follow-up is conducted as needed.

Fundamental Practice

CA-ECE 5.03

Procedures for regularly cleaning and sanitizing the classroom limit the spread of infection and include:
  1. daily cleaning of the facility;
  2. disinfecting bedding, beds, cots, cribs, and mats at least once a week and between use by different children;
  3. disinfecting toys and other materials at least weekly and immediately after use if items are placed in the child’s mouth; and
  4. the availability of properly labeled disinfectants, which are securely stored away from children at all times.
Note: Please see the Facility Observation Checklist for additional guidance on this standard.

Fundamental Practice

CA-ECE 5.04

To limit the spread of infection, diaper changing areas:
  1. are separate from food preparation areas;
  2. have a posted copy of diaper changing procedures;
  3. utilize changing tables made of non-porous material; and
  4. include covered, plastic-lined, hands-free cans for the disposal of used diapers.
NA The organization does not provide care to children in diapers.

Fundamental Practice

CA-ECE 5.05

Diapering procedures meet nationally recognized guidelines for sanitary diapering practices, and include:
  1. that children are never to be left unattended on changing tables and that one hand must be on the child at all times;
  2. proper disposal of diapers and other contaminated items;
  3. proper use of gloves when they are offered to teaching staff;
  4. steps for gathering materials ahead of time;
  5. relevant hand-washing requirements; and
  6. steps for disinfecting the area after each use.
NA The organization does not provide care to children in diapers.
Examples: The 2nd Edition of Caring for Our Children, which is a joint partnership of the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care, offers detailed diaper changing procedures that organizations may find useful when developing their own diapering practices.

Fundamental Practice

CA-ECE 5.06

Hand washing areas are designed to promote safety and limit the spread of infection including:
  1. separating hand-washing sinks from food preparation sinks;
  2. installing shatter-proof mirrors;
  3. making hand washing sinks easily accessible to all children; and 
  4. having liquid soap and sanitary methods for drying off hands available.
Examples: Sanitary methods for drying off hands include disposable paper towels or electric dryers that turn on and off automatically.

Fundamental Practice

CA-ECE 5.07

Hand washing procedures meet nationally recognized guidelines for hand washing and include:
  1. under what situations hands must be washed;
  2. requirements for water temperature, soap use, and time spent scrubbing and rinsing; and
  3. procedures for turning off water that reduce the risk of recontamination.
Examples: The 2nd Edition of Caring for Our Children, which is a joint partnership of the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care, has hand washing procedures that organizations may find useful when developing their own hand washing practices


CA-ECE 5.08

Teaching staff promote good health habits by:
  1. modelling and providing developmentally-appropriate instruction on health and hygiene practices;
  2. serving nutritious meals and snacks; and
  3. providing opportunities for active play.
Examples: Health and hygiene practices include, but are not limited to:
  1. washing hands before and after eating;
  2. washing hands after using the bathroom;
  3. covering the nose and mouth when sneezing or coughing; and
  4. regular tooth brushing.

Examples: Active play for infants may include “tummy time,” allowing infants to develop the muscles of their back and neck.

Fundamental Practice

CA-ECE 5.09

Teaching staff:
  1. follow universal precautions;
  2. identify and report suspected child abuse and neglect to prescribed authorities;
  3. are informed about children in their care with special medical needs or allergies; and
  4. are healthy and capable of performing the essential functions of the job with reasonable accommodation.


While an annual physical examination is preferred, teaching staff may receive a general health screening performed by a qualified medical practitioner, provided the screening addresses communicable diseases.

Fundamental Practice

CA-ECE 5.10

There is at least one person on duty and available at all times the program is in operation, including on field trips away from the program site, that has completed training in basic first aid and age-appropriate CPR in the previous two years that included an in-person, hands-on CPR skills assessment conducted by a certified CPR instructor.


CA-ECE 5.11

A health facility or qualified medical professional is available to provide:
  1. medical consultation to the organization and parents;
  2. a review of children’s health needs; and
  3. a review of the organization’s health and safety practices.


The intent of this standard is not to require that organizations pay for this service, but to ensure they have access to medical professionals as needed.
Examples: Organizations may ensure access to medical professionals by having medical professionals on staff or by developing formal or informal relationships with medical professionals outside the organization to receive assistance when special health needs arise.

Fundamental Practice

CA-ECE 5.12

Bottles of breast milk and formula are:
  1. labeled with the child’s full name and the date that it was brought in;
  2. brought in daily and stored in a refrigerator upon arrival;
  3. discarded if the bottle is not finished in one feeding; 
  4. warmed in water and never in a microwave oven; and
  5. sent home at the end of the day so thawed breast milk and mixed formula are never stored overnight by the centre.
NA The organization does not provide infant care.

Fundamental Practice

CA-ECE 5.13

Teaching staff take necessary precautions to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related infant deaths, including:
  1. placing infants on their backs for sleep unless otherwise instructed by the child’s doctor;
  2. placing infants on a firm sleep surface such as a safety-approved crib mattress with fitted sheet;
  3. never allowing children to sleep in a device meant for sitting such as a carseat, bouncer, or swing;
  4. removing soft materials or objects such as pillows, loose bedding, bumper pads, or toys from sleep areas;
  5. ensuring sleep spaces are free of strangulation hazards such as dangling cords, electric wires, and window-covering cords; and
  6. dressing infants appropriately for the environment.
NA The organization does not provide infant care.

Fundamental Practice

CA-ECE 5.14

A safe environment is maintained through proper selection and maintenance of play equipment, including:
  1. indoor and outdoor playground equipment that meets national safety standards;
  2. installing equipment on an appropriate amount of impact absorbing surfaces in accordance with manufacturer’s instructions and/or industry practice;
  3. conducting daily inspections of playground equipment and the surrounding area to immediately identify potentially hazardous conditions;
  4. monthly inspections of playground equipment to identify signs of wear or damage using a standardized checklist and in accordance with manufacturer’s instructions; and
  5. annual inspections and necessary maintenance of the play equipment by industry professionals.
Examples: Potentially hazardous conditions include standing water, broken glass, or damage to the play equipment. Signs of wear or damage include worn or damaged wood, bolts, chains, anchors, or insufficient amount of impact absorbing surfaces under equipment.

Fundamental Practice

CA-ECE 5.15

Stairwells have railings and are closed off from child care classrooms.
NA None of the organization's ECE facilities have stairwells.


CA-ECE 5.16

The facility provides an optimal care and learning environment that is:
  1. clean;
  2. welcoming;
  3. well lit, with natural light where possible and emergency lighting throughout;
  4. maintained at a safe, comfortable temperature and noise level;
  5. odour free; and
  6. adequately ventilated.

Fundamental Practice

CA-ECE 5.17

Smoking is prohibited anywhere on the premises, including outside entrances, outdoor play areas and program vehicles.

Fundamental Practice

CA-ECE 5.18

The organization:
  1. ensures equipment, toys, and materials are child-proof, non-toxic, and maintained in good repair; and
  2. is aware of and responsive to any product recalls affecting equipment, toys, and materials.
Examples: The Consumer Product Safety Commission provides web-based access to a list of product recalls.