Annexure A: FORM 1: SELF-ASSESSMENT FORM to be completed by an early childhood development programme and/or partial care facility that provides an after-school service PRIOR to re-opening under the national state of disaster
To be submitted in line with the Department of Social Development's Circular dated 21 June 2020 by 6 JULY 2020.

This self-assessment form must be completed by an early childhood development programme and/or partial care facility that provides an after school service and intends to re-open under duration of the state of disaster, subject to the pronouncement of a date and the conditions of such re-opening by the Minister of Social Development.

This SELF-ASSESSMENT is a series of questions and statements based on the minimum health, safety and social distancing measures on COVID-19 that an early childhood development programme and/or partial care facility must comply with before it may re-open and receive children again. It helps you, when you answer the questions truthfully, to be certain that you meet the minimum requirements, and also provide the information on your own assessment to the Department of Social Development to confirm that you have checked all the measures yourself.

Please READ the following before you complete this self-assessment:
1. The completion and submission of this form does not mean that you can re-open the early childhood development programme and/or partial care facility. It may only be re-opened when the Minister of Social Development has announced a date for the re-opening and if you meet all the requirements as indicated below and in sections 4.1 and 4.2.

2. Please do not complete this form unless you have completed all the preparations needed to comply with the minimum health, safety and social distancing measures on COVID-19 before re-opening (the relevant information can be found in the DSD’s Standard operating procedures and guidelines for early childhood development programmes and partial care facilities on COVID-19). Your answers need to be based on these preparations.

3. You must answer all the sections and questions that apply to your type of programme. If it does not apply, please mark the ‘not applicable’ option.

4. The information that you provide in this self-assessment will be submitted to the DSD, who may conduct a site visit prior to the re-opening date (still to be announced) or anytime thereafter to check whether the information provided is correct.

5. If you have completed the self-assessment form and have indicated that you are ready to reopen, this information will be submitted to the Provincial Department of Social Development who may conduct a site visit to verify this.

IMPORTANT: This self-assessment form may only be completed by a person authorized (have the permission) by the ECD programme and/or partial care facility manager/ principal/ owner to complete it.

IMPORTANT: All sections and questions marked with an * are compulsory and must be completed.
Email address *
A1. HAVE YOU SUBMITTED THIS SELF-ASSESSMENT BEFORE? *
Mark ONE (1) only.
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