Free Printable Infant Sleep-Check Log

Who needs a 15-minute sleep-check record?

California family child care home providers must physically check sleeping infants every 15 minutes under 22 CCR § 102425(j)(1). Infant care center staff have the same physical-check interval under 22 CCR § 101429(a)(2)(B). The two sections also set documentation requirements, so knowing which section applies to your setting matters.

This form is a recordkeeping aid. It does not perform a physical check or provide supervision. Family child care providers must stay near enough to hear the infant wake, remain on the same floor, and, if the infant sleeps in a separate room, keep that door open at all times and be able to see the infant without moving the door (22 CCR § 102425(j)(4), (j)(5) and (j)(6)). In infant care centers, sleeping infants must be directly observed by sight and sound at all times, including while going to sleep and waking (22 CCR § 101429(a)(2) and (a)(2)(A)).

What belongs on the log?

For family child care homes, the documented record must include the date, the infant's name, and the time of each 15-minute check. Keep the documentation in the infant's file and available to the Department for review (22 CCR § 102425(j)(2)(D)). For infant care centers, the record must also include the initials of the staff person who conducted each check (22 CCR § 101429(a)(2)(C)).

The template includes those fields plus spaces for observations: whether the infant is on their back, whether breathing appears normal, and notes about signs of distress. These prompts help you document what you physically observed; a blank or completed box does not change the care or supervision requirements.

Both sections require documentation of labored breathing, signs of distress such as flushed skin color, increased body temperature and restlessness, and infants up to 12 months sleeping in a position other than on their back (22 CCR § 102425(j)(2)(A), (j)(2)(B) and (j)(2)(C); 22 CCR § 101429(a)(2)(B)). The Y/N columns are template prompts, rather than the wording of the regulations.

How to use the blank printable form

1. Print the landscape sheet. Fill in the facility, date, room and provider fields, then write each infant's name above their table. Facility, room and provider are helpful organizing fields on this template.
2. Use a row for each physical check. Enter the actual time in the blank time cell, mark the position and breathing prompts, write observation notes when needed, and add the initials of the person who performed the check.
3. Use another sheet when you need more rows or room for notes. Keep the infant's name and date clear on each sheet so the pages can be read together.
4. Keep completed documentation in the infant's file and available for Department review, as specified in 22 CCR § 102425(j)(2)(D) or 22 CCR § 101429(a)(2)(C).

If an infant up to 12 months is sleeping in another position and Section C of their Individual Infant Sleeping Plan is not completed, the provider or staff must return the infant to their back (22 CCR § 102425(j)(2)(C); 22 CCR § 101429(a)(2)(B)). Read the LIC 9227 sleeping plan guide for the separate rolling and medical-exemption provisions.

When an observation needs action

Writing a note is only the documentation step. For family child care homes, observed labored breathing or distress requires immediate notification of the authorized representative, obtaining specific instructions, and prompt arrangements for medical treatment if necessary; emergency treatment must not be delayed when immediate attention is required (22 CCR § 102425(j)(3)). For infant care centers, staff must obtain emergency medical treatment and immediately notify the authorized representative when they observe labored breathing or distress (22 CCR § 101429(a)(2)(B)).

Review the California Title 22 infant sleep rules for the full family child care home text and the center differences. Confirm current requirements with Community Care Licensing before relying on this reference.