Paper Form User Guide

This National Digital Car Seat Check Form Paper Form User Guide provides guidance on how to complete version 9.0 of the paper form.

Complete the vehicle information even if the caregiver received a ride to the car seat check from someone else (e.g., friend, relative, support program). If the caregiver did not arrive in a passenger vehicle (e.g., public transportation, on foot), this information may be left blank. Document reason in Documentation Box.

• Vehicle Make
• Vehicle Model
• Vehicle Trim: The trim level is an extension of the vehicle model description. For example: Honda Accord LXI , LXI would be the trim level.

Vehicle Year

• Verify vehicle information: Verify the vehicle year by checking for the vehicle manufacture date on the driver side door frame, front of the A-pillar.
• Vehicle information can be verified by entering the license plate number into Check to Protect vehicle recall search website: https://checktoprotect.org/

Visit checktoprotect.org to check for open vehicle recalls.

• Encourage the caregiver to use their cell phone (if available) or another electronic device to search for open vehicle recalls.
• If the caregiver is unable to check for a recall, the Technician should search for a recall.
• If a recall is identified, use the Check to Protect website to locate a dealership and encourage the caregiver to contact a local dealership to schedule an appointment have the recall repaired for free. Note: Internet connection required.

 

Complete the vehicle information even if the caregiver received a ride to the car seat check from someone else (e.g. friend, relative, support program, etc.).  If the caregiver did not arrive in a passenger vehicle (e.g. public transportation, on foot, etc.), this information may be left blank. Document reason in documentation box on page 2.

• Vehicle Make
• Vehicle Model
• Vehicle Trim: The trim level is an extension of the vehicle model description. For example: Honda Accord LXI , LXI would be the trim level.
• Vehicle year

Vehicle information can be verified by entering the license plate number into Check To Protect or Check To Protect-Spanish vehicle recall search service.

What Agency is hosting this seat check? Document the agency providing the car seat check. Begin typing the agency name in the box until it appears in the list and select it.

Agency affiliation is not required to use the National Digital Car Seat Check Form. Any currently certified Technician can use the NDCF to track seat check data. Independent Technicians may leave this blank.

What state is this seat check taking place in? 

Document the state in which the Technician is performing the car seat check. (This may be different than the caregiver state). If the seat check is part of a virtual event, select the state in which the Technician is located.

Event

Provide a description of event. (e.g. Seat Check Saturday, one-on-one appointment, etc.).

• Use this field to differentiate between multiple events hosted by an agency on the same day or to easily sort and filter data to share with a partnering organization.
• Technicians may use this field to record additional agencies hosting the event.

Has the caregiver attended a car seat check previously? Document the caregiver’s response.  

Document all Technicians who participated in the car seat check, including last name and Technician certification number.

• If the seat check will be used for re-certification, be sure to add the Instructor or proxy name.
• If multiple Technicians are assisting a caregiver but not participating in the assessment of all the children in the caregiver vehicle, record the name of the Technician(s) who performed the assessment in the Documentation Box.

What brought the caregiver to the car seat check? Document how the caregiver heard about the car seat check.

Has the caregiver attended a car seat check previously? Document the caregiver’s response.

Child # Assign each child a number and document.

1. Vehicle present

Identify if the caregiver arrived in a passenger vehicle that is available to perform inspection. If the caregiver arrived by public transportation, on foot, etc., select No.

2. Child Location in Vehicle

Document where the CHILD is located in the vehicle on arrival, even if the child is unrestrained. This location may be different than the location of the child’s CAR SEAT as documented in question 8.

• If no vehicle is present, select N/A.
• If the child is not physically present, select No Child Present.
• Add additional location information for the 4th row to the Documentation Box.
• Note: If the child arrived in a different vehicle but will also be assessed in this vehicle, instruct the caregiver to secure the child as they normally would and proceed with the seat check.

3. Child’s Age

Select the age range of the child even if the child is not present.

• Unborn: Select if this is a prenatal seat check and go to #8.
• 0<1: Select if child’s age is less than one year. Complete #1a.

3a. If child is under 1 year, select the age in months

Complete this question only if the child is born and less than 1 year old. Select the child’s age range in months.

4. Weight (lbs.)

Document the child’s weight in pounds. If weight is unknown, document estimated weight. Make note in the Documentation Box.

5.  Height (inches)

Document the child’s height in inches. If height is unknown, document an estimated height. Make note in the Documentation Box.

• Note: If the caregiver is unsure of the child’s height and weight, the Technician has the option to verify height and weight if possible. If child is not present or is unborn and there is no way to provide a height estimate, enter 00 and make a note in the Documentation Box.

6. How were weight and height collected?

• Caregiver Reported/Other Source- Select whether the caregiver reported the child’s weight and height, or information was verified by another source (e.g., hospital records, WIC, etc.).
• Measured at Car Seat Check– Child was present and measured at the car seat check.

7. Child Secured Using

Select how the CHILD is secured on arrival.

• Older children: If child is using a booster seat or seat belt, answer 7a. Child Seat Belt Correct, otherwise skip to #8.
• N/A- select if no vehicle present.

7a. Child Seat Belt Correct

Answer this question only if the child arrived in a booster seat or using a seat belt. Indicate if the seat belt is being used correctly.  No: select all that apply.

• Incorrect Fit on Child: Select if the seat belt across the neck, shoulder, or stomach, etc.
• Shoulder Belt: Select if the shoulder belt is misrouted when used with a booster, placed behind the back or tucked under the arm, too loose, etc.
• Lap Belt: Select if the lap belt is misrouted when used with a booster, too loose, etc.
• If a description of seat belt error is not listed, provide a brief description in the Other box. If more detail is necessary, describe in the Documentation Box.

8. CS Location in Vehicle

Document where the CAR SEAT (CS) is located in vehicle on arrival. This location may be different than the location of the CHILD as documented in question #2. Child Location in Vehicle.

• D represents the driver’s location.
• 2nd Row: If the vehicle only has one back row (e.g., sedan), use this option and leave 3^rd row blank.
• No CS: Select if the child does not have a car seat and proceed to #36.\
• Uninstalled: Select if the car seat is present but not secured in a seating position (e.g., in vehicle trunk, in a box).
• 4th Row: Select this option for vehicles with more than three rows (e.g., 15- passenger vans).  Add additional information for the 4th row to the Documentation Box.
• Note: If the child arrived in a different vehicle but will also be assessed in this vehicle, instruct the caregiver to secure the child as they normally would and proceed with the seat check.

9. CS Type

Check restraint type being used on arrival. Note: If the car seat is an All-in-One, choose the option that best describes how it was installed. (e.g. RF Convertible, FF with Harness, Backless Booster, High-back Booster).

10. CS Harness Correct

Document if the car seat harness is being used correctly on arrival.  If no child is present, identify any misuse related to general harness use as directed by the car seat manufacturer user guide. If the child arrived in a car seat/booster seat/seat belt and has been removed prior to assessment, instruct the caregiver to place the child back into the car seat/booster seat/seat belt without providing any instruction to accurately document all misuse.

•  No: Select all misuse that applies.
• If unborn and harness errors are observed, select No.
• If a description of harness error is not listed, provide a brief description in the Other box. If more detail is necessary, include it in the Documentation Box
• N/A: Check if child arrived in a booster or seat belt only.

11. CS Installed Using

If the car seat is uninstalled, Skip to #23. Document the way the car seat is installed in the vehicle on arrival; select all that apply.  Document additional findings in the Documentation Box if necessary.

• Booster: If the booster seat was installed in the vehicle (e.g. lower anchors, top tether, uninstalled etc.) select how the seat was installed. If child is present, choose the best response option to describe how the booster was secured. Example: Child present, booster secured using LA, select LA and seat belt type that is used to secure the child.  If the child was not present, select how the booster was secured.

12. Recline Angle Correct

Document if the car seat is reclined according to the car seat manufacturer’s instructions on arrival.

• No: Select misuse.
• N/A: Select if recline angle does not apply to this car seat.

13. Lower Anchors Correct

If the car seat is installed using lower anchors, document if the lower anchors are used correctly on arrival.

• No: Select all misuse.
• If a description of lower anchor misuse is not listed, provide a brief description in the “other” box. If more detail is necessary, describe in the Documentation Box.
• N/A: Check if the car seat is not installed with lower anchors.

14. Seat Belt Correct

If the car seat is installed using a seat belt, document if the seat belt is used correctly on arrival.

• If No, select all misuse that applies.
• If a description of seat belt misuse is not listed, provide a brief description in the Other box. If more detail is necessary, include it in the Documentation Box.
• N/A: Check if the car seat is not installed with a seat belt.

15. Tether Correct

Document if the tether is used per car seat manufacturer’s instructions on arrival.  

• No: Select all misuse that applies.
• If a description of tether misuse is not listed, provide a brief description in the Other box. If more detail is necessary, include it in the Documentation Box
• N/A: Check if the car seat does not have a tether or if a tether is present and not being used per the car seat manufacturer’s instructions (e.g., a convertible seat in the rear-facing position).

Are these features used correctly?

16. Carry Handle Position

Document if the carry handle is being used according to the car seat manufacturer’s instructions on arrival.

• N/A: Check if the car seat does not have a carry handle.

17. Load Leg

Document if the load leg/foot prop is being used according to the car seat manufacturer’s instructions on arrival.

• N/A: Check if the car seat does not have load leg/foot prop.

18. Anti-Rebound Bar

Document if the anti-rebound is being used according to the car seat manufacturer’s instructions on arrival.

• N/A: Check if the car seat does not have an anti-rebound bar.

19. Rotating Car Seat Locked

Document if the rotating feature on the car seat is in a locked position on arrival.

20. Are there non-approved products?

Document if the caregiver is using any non-approved products on, under, or next to the car seat or on the seat belt on arrival, e.g.: Mirrors, rattle toys, tablets, etc.

• Yes: Document additional information in the Documentation Box.

21.  CS Correct Direction Per MFR’s Instructions

Based on the child information and the car seat manufacturer’s instructions, document if the car seat is installed facing the correct direction on arrival.

22.  CS Installed Per MFR’s Instructions

Based on the information collected in #11 through #21, document if the car seat is installed according to the car seat manufacturer’s instructions on arrival.

• Unknown: Check if the car seat instruction manual is unavailable to verify if the car seat is installed according to the car seat manufacturer’s instructions.

23. CS Correct for Child Age, Weight, and Height per MFR’s Instructions

Based on information collected in question 1-3, and the car seat manufacturer’s instructions, determine if the child meets the age, weight, and height requirements of the car seat. Measure on site or discuss with caregiver to determine child’s weight and height.

• Unborn Child: Select yes if the car seat can be used rear facing.
• Unknown: Check unknown if the car seat instruction manual is unavailable and verification of weight and height is not possible.

24.  CS Correct Per State’s Law

Based on the information collected, determine if the car seat is appropriate/used according to the current state law.

• N/A: Check if the state law does not apply to the current car seat check.  To view your State’s CPS law, visit Governors Highway Safety Association.

25. CS Labels Missing

Document if the car seat being used on arrival is missing labels needed to identify general use information.

• Yes: Complete as much information as possible in #25 – #33.

26. CS MFR

Document the manufacturer name of the car seat being used on arrival.

27.  Model Name

Document the model name of the car seat being used on arrival.  Leave this field blank if a car seat model name is not identified, enter U in the text box.

28. Model Number

Document the model number of the car seat being used on arrival.

29. MFR Date (MM/DD/YYYY)

Document the date of manufacture of the car seat being used on arrival.

30. Expiration Date (MM/DD/YYYY)

Document the expiration date, if available, of the car seat being used on arrival. Leave this field blank if the expiration date cannot be determined.

31. CS Expired

Determine and document if the car seat being used on arrival is expired. Unknown: Check if unable to determine if the car seat is expired.

32. CS Recalled

Using the car seat information collected, identify any recalls on the car seat being used on arrival and document them in the Documentation Box.  If the recall has been repaired, document in the Documentation Box.

• Unknown: Check if unable to determine if the car seat is recalled. To view the most recent recall link, visit NHTSA.gov. Internet connection required.

33. CS History Known

Determine and document if the history of the car seat being used on arrival is known.

34. CS Involved in a Crash

Determine and document if the car seat being used on arrival has been involved in a crash. Note: If the car seat has been involved in a crash or if the history of the car seat is unknown, consider the need to replace the car seat. For more information: NHTSA Car Seat Use After a Crash.

35. CS Registered

Determine and document if the car seat being used on arrival is registered with the car seat manufacturer, using the caregiver’s current address. If the car seat is not registered or if it is unknown if the car seat is registered, provide guidance to the caregiver on how to register the car seat. Consider registering the car seat on-site prior to the caregiver leaving the car seat check.

36. Child/CS Location in Vehicle

Document where the CHILD and the CAR SEAT are located in the vehicle on departure. These should be the same location in the vehicle.

• Driver represents the driver’s location.
• 2nd Row: If the vehicle only has one back row (e.g., sedan), use this option and leave 3^rd row blank.
• 4th Row: Select this option for larger vehicles with more than three rows (e.g., 15- passenger vans).  Add additional location information for the 4^th row to the Documentation Box

Demonstration Only: Check if the car seat is installed on a vehicle demonstration seat, not in a vehicle. Installation on a vehicle demonstration seat should only be done when no other options are available

37. Restraint Type

Check restraint type being used on departure. Note: If the car seat is an All-in-One, choose the option that best describes how it was installed (e.g. RF Convertible, FF with Harness, Backless Booster, High-back Booster)

38. Child Secured Using

Select how the CHILD is secured on departure.

• No Child Present: Select if no child is present at the car seat check.
• Document how the CAR SEAT is installed in the vehicle on departure. Select all that apply. Document additional findings in the Documentation Box
• Uninstalled: Select if the car seat is present but not secured in a seating position (e.g., in vehicle trunk, in a box).
• No CS: Check if a child left without a car seat. Proceed to #48.

39. CS Installed Using   

Document how the CAR SEAT is installed in the vehicle on departure. Select all that apply. Document additional findings in the Documentation Box

• Uninstalled: Select if the car seat is present but not secured in a seating position (e.g., in vehicle trunk, in a box).
• No CS: Check if a child left without a car seat. Proceed to #48.

40. Is this the same CS as ‘On Arrival’?

Document if the same car seat is used on arrival and departure.

• Yes: If the same car seat is used on arrival and departure, skip to #46.

40a. If no, CS provided by

Document who provided the car seat for the child on departure.

40b. Meets Eligibility Requirements

Check box if the caregiver meets the eligibility requirements to receive the car seat provided by the donor in #40a. Document any additional local information in the Documentation Box. If there are no eligibility requirement, leave blank.

41. CS MFR

Document the manufacturer name of the car seat being used on departure.  If the manufacturer information cannot be determined, enter Unknown in the text box. If the manufacturer is not listed, select Other and enter the manufacturer information.

42. Model Name

Document the model name of the car seat being used on departure. If the model information cannot be determined, enter U in the text box.

43. Model Number

Document the model number of the car seat being used on departure. If the model number cannot be determined, enter U in the text box.

44. MFR Date (MM/YYYY)

Document the expiration date, if available, of the car seat being used on departure.

45. Expiration Date

Document the expiration date, if available, of the car seat being used on departure.

46. CS Registered for Recalls By

Document who is responsible for registering the car seat being used on departure.

• N/A: Select if no car seat is being used on departure.

47. Is the CS compatible with the vehicle?

Document if the car seat being used on departure is compatible with the vehicle.  

• Note: If there was any incompatibility on arrival, document issues in the Documentation Box.
• Yes, without difficulty: Proceed to #48.
• Yes, with difficulty: Answer #47a.
• No, a different car seat is/was needed: Answer #47a.
• CS uninstalled: Proceed to #48

47a. What difficulties did you encounter?

Select all difficulties that you encountered when installing the car seat being used on departure.

• Other: If a description of the installation difficulty is not listed, provide a brief description in the Other box. If more detail is necessary, include it in the Documentation Box

48. Child/CS Correct on Departure    

Document if all corrections were made to the car seat prior to departure. Complete this question even if there is no child present.

• No: Provide an explanation as to why all corrections are not made in the Documentation Box. Only select No if the seat is not correct for the child or the seat is otherwise unusable (expired, damaged, or incorrect seat selection – age, height, weight).

Documentation Box    

Document seat check details. Do not put personal information in the box.

Check all topics discussed with caregiver. Nationally certified CPS Technicians can access the 2024 Child Passenger Safety Technician Certification Training — Technician Guide for additional information about the following topics as indicated below.

• Airbags: Location and potential danger of airbags to children and out of position occupants.
• Unused seat belts: Strangulation dangers of unused seat belts. Additional information is available at Car Seat Safety Seat Belt Entanglement
• Projectiles: Loose objects in the vehicle that can cause injury.
• Premature transition: Potential risks from moving from rear-facing to forward-facing and harness to booster seat too soon.
• Heatstroke: Prevention tips to avoid hot car deaths. Additional information is available at Heatstroke Prevention | CPS Board.
• Next steps: Change of direction from rear-facing to forward-facing, transition to next car seat stage, etc.
• Best practice vs. state law: Guidance on best practice recommendations vs. state law.
• Safety in and around cars: Dangers of leaving children unattended in and around cars.
• Additional information is available at Heatstroke Prevention | CPS Board.
• CS recycled: What to do with a car seat when it reaches its expiration date. Encourage caregivers to check with local recycling programs. Refer caregivers to car seat manufacturer information on car seat recycling.
• Bulky clothing: Dangers of securing a child in a car seat with bulky winter clothing. Additional information is available at Winter Car Seat Safety Tips: Keeping Kids Safe & Warm – HealthyChildren.org
• Vehicle recall: Find out if the caregiver’s vehicle has an open recall. It’s free to check and free to repair at a dealer. Visit Vehicle Recall Check by VIN or License Plate | Check to Protect.
• Safe Sleep: Infant sleep safety recommendations available at How to Keep Your Sleeping Baby Safe: AAP Policy Explained – HealthyChildren.org.

35. Child/CS Location in Vehicle

Document where the CHILD and the CAR SEAT are located in the vehicle on departure. These should be the same location in the vehicle.

D represents driver location.

2nd Row: If the vehicle only has one back row (e.g. sedan), use this option and leave 3^rd row blank.

4th Row: Select this option for larger vehicles with more than three rows (e.g. 15- passenger vans). Add additional location information for the 4^th row to the Documentation Box on page 2.

Demonstration Only: Check if the car seat was not installed in a vehicle on departure (e.g. no vehicle present, vehicle demonstration only, portable vehicle demonstration seat). Note: Installation on a vehicle demonstration seat should only be done when no other options are available.

36. Restraint Type

Check restraint type being used on departure. Note: If the car seat is an All-in-One, choose the option that best describes how it was installed (e.g. RF Convertible, FF with Harness, Backless Booster, High Back Booster)

CS= Car Seat     RF= Rear-Facing   FF= Forward-Facing

RF Only without Base: Any rear-facing only car seat designed for use only by a young child in a semi-reclined rear-facing position; not permitted by manufacturer to be used forward-facing; also referred to as infant car seat; only the carrier is present.

High Back Booster: Booster seat (or combination or all-in-one car seat being used in the booster mode) with a shell that provides head, neck, and back support for the child; raises and positions the child using a lap-and-shoulder belt.

RF Only with Base: Any rear-facing only car seat designed for use only by a young child in a semi-reclined rear-facing position; not permitted by manufacturer to be used forward-facing; also referred to as infant car seat; the carrier and detachable base are present.

Backless Booster: Booster seat (or combination or all-in-one car seat being used in the booster mode) that uses the vehicle’s seat back or head restraint for head, neck, and back support for the child; raises and positions the child using a lap-and-shoulder belt; also referred to as low-back booster seat or no-back booster seat.

Base Only: Detachable base for rear-facing only car seat; the carrier is not present.

Adaptive Restraint: Car seats and booster seats obtained through a specialized provider for use with children who have adaptive transportation needs.

RF Convertible: Car seat that can be used rear-facing and forward facing. Select this option when the car seat is being used rear-facing.

Vest: A harness system used in place of a car seat or booster seat; works with either the vehicle seat belt system or LATCH.

FF with Harness: Forward-facing car seat being used with harness including convertible, combination, all-in-one, forward-facing only, and integrated car seats.

Other: Document restraint type if it does not fit any of the options above.

37. Child Secured Using

Select how the CHILD is secured on departure.

No Child Present: Select if no child is present at the car seat check.

38. CS Installed Using

Document how the CAR SEAT is installed in the vehicle on departure; select all that apply.

Document additional findings in the Documentation Box on page 2.

Uninstalled: Select if the car seat is present but not secured in a seating position (e.g. in vehicle trunk, in a box).

No CS: Check if a child left without a car seat. Proceed to #47.

39. Is this the same CS as ‘On Arrival’?

Document if the same car seat is used on arrival and departure.

Yes: If the same car seat is used on arrival and departure, skip to #45.

39a.

If no, CS provided by: Document who provided the car seat for the child on departure.

39b.

Meets Eligibility Requirements– Check box if the caregiver meets the eligibility requirements to receive the car seat provided in #39a. Document any additional local information in the Documentation Box on page 2.

40. CS MFR

Document the manufacturer name of the car seat being used on departure.

41. Model Name

Document the model name of the car seat being used on departure.

Leave this field blank if the car seat model name is not identified.

42. Model Number

Document the model number of the car seat being used on departure.

43. MFR Date (MM/DD/YYYY)

Document the date of manufacture of the car seat being used on departure.

44. Expiration Date (MM/DD/YYYY)

Document the expiration date, if available, of the car seat being used on departure.

45. CS Registered for Recalls By

Document who is responsible for registering the car seat being used on departure.

N/A: Select if no car seat is being used on departure.

46. Is the CS compatible with the vehicle?

Document if the car seat being used at departure is compatible with the vehicle. Note: If there was any incompatibility on arrival, document issues in the Documentation Box.

Yes: Proceed to #47.

Yes, with difficulty: Select if the CS position in the vehicle had to be changed due to a compatibility issue, then continue to 46a to explain the difficulty.

No, need different CS: Answer #46a.

CS uninstalled: Proceed to #47.

46a. What difficulties did you encounter?

Select all difficulties that you encountered when installing the car seat being used on departure.

Other: If a description of the difficulty is not listed, provide a brief description in the “other” box. If more detail is necessary, describe in the Documentation Box on page 2.

47. Child/CS Correct on Departure

Document if all corrections are made prior to departure. Complete this question even if there is no child present.

No: Provide an explanation as to why all corrections are not made in the Documentation Box on page 2. Only select “No” if the seat is not correct for the child or the seat is otherwise unusable (expired, damaged, or incorrect seat selection – age, height, weight).

Circle all topics discussed with caregiver as applicable.

Nationally certified CPS Technicians can access the 2020 National Child Passenger Safety Technician Certification Training Technician Guide (TG) for additional information about the following topics as indicated below.

Airbags: Location and potential danger of airbags to children and out of position occupants. (TG Module 5)

Unused seat belts: Strangulation dangers of unused seat belts Information is available at cpsboard.org/car-seat-safety/car-seat-safety-entanglement/.

Projectiles: Loose objects in vehicle that can cause injury. (TG 3-2)

Premature transition: Potential risks from moving from rear-facing to forward-facing and harness to booster seat too soon. (TG Modules 7-10)

Heatstroke: Prevention tips to avoid hot car deaths (TG 12-5). Additional information is available at cpsboard.org/heatstroke.

Next steps: Change of direction from rear-facing to forward-facing, transition to next car seat stage, etc. (TG Modules 7-10)

Best practice vs. state law: Guidance on best practice recommendations vs. state law. (TG 2-4 and 7-3)

Safety in and around cars:  Dangers of leaving children unattended in and around cars (TG 12-5). Additional information is available at cpsboard.org/heatstroke.

CS recycled: What to do with a car seat when it reaches its expiration date. Encourage caregivers to check with local recycling programs. Refer caregivers to car seat manufacturer information on car seat recycling.

Bulky clothing: Dangers of securing a child in a car seat with bulking winter clothing: AAP Recommendations.

Vehicle recall: Find out if the caregiver’s vehicle has an open recall. It’s free to check and free to repair at a dealer. Visit Check to Protect.

Safe Sleep: Infant sleep safety recommendations available at healthychildren.org.

Virtual Check

Fill in the circle if the car seat check information is being collected as part of a virtual car seat check and the form is being signed off by the technician instead of the caregiver.

If caregiver initials were not captured at an in-person event, enter N/A and add notes to the Documentation Box.

48. I harnessed a child/doll in the child seat.

The caregiver indicates if he/she harnessed a child/doll in the car seat.

No: Provide explanation in the Documentation Box on page 2.

N/A: Check if there is no child or doll present.

49. I installed my car seat today.

The caregiver indicates if he/she installed the car seat today.

No: Provide explanation in the Documentation Box on page 2.

N/A: Select if the car seat is not installed in a vehicle or it is installed on a vehicle demonstration seat.

50. Caregiver’s Initials

The caregiver acknowledges #48 and #49 by signing his/her initials.

• For a virtual seat check, write the word VIRTUAL

Virtual Check

Fill in the circle if the car seat check information is being collected as part of a virtual car seat check and the form is being signed off by the Technician instead of the caregiver. If caregiver initials were not captured at an in-person event, enter N/A and add notes in Documentation Box.

49. I harnessed a child/doll in the child seat.

The caregiver indicates if he/she harnessed a child/doll in the car seat.

• No: Provide explanation in the Documentation Box. N/A: Check if there is no child or doll present.

I installed my car seat today

• The caregiver indicates if he/she installed the car seat today.
• No: Provide explanation in the Documentation Box.
• N/A: Select if the car seat is not installed in a vehicle or it is installed on a vehicle demonstration seat.

Caregiver’s Initials

The caregiver acknowledges #49 and #50 by signing his/her initials. For a virtual seat check, write the word VIRTUAL.

Final Inspection

52. Caregiver Donation

Document if the caregiver provides a donation.

• Donation Amount: If the caregiver provides a donation, enter the donation amount.

53. Educational materials given?

Caregiver acknowledges if educational materials are provided.

54. Final Inspection Signoff

Document a final sign off by a senior checker, an Instructor, or a Technician Proxy prior to departure, if required. If not required, leave blank.

55. Is this CS for recertification?

Check the appropriate box.

55a. If yes:

Document if the Technician passed or failed the seat check for recertification.

55b. Mock Seat Check

Check the appropriate box. Mock seat checks are not a formal seat check. For more information about seat sign offs, please visit Safe Kids Certification.

Documentation Box: Document seat check details. Do not put personal information in the box.