How to Fill Out the California Infant Sleep Observation Form (LIC 9227)

The LIC 9227 form, California’s Individual Infant Sleeping Plan, is a one-page document you complete for every infant under 12 months in your licensed child care. Fill in Sections A and B for every baby during enrollment, add Sections C, D, or E only when rolling ability or a medical exemption applies, and keep the completed form in that child’s file alongside a 15-minute sleep observation log. Download it free from the California Department of Social Services in English, Spanish, Korean, Chinese, or Vietnamese.

Where to Download the Form

The LIC 9227 lives on the CDSS forms page under the I–L alphabetical listing.¹ The CDSS safe sleep resource page links directly to all five language versions.² Print copies before enrollment day. You need a fresh form for every infant, and Community Care Licensing evaluators will expect to see one in each child’s file during site visits.

Both Child Care Centers (under Title 22 Section 101430) and Family Child Care Homes (under Section 102425) use the same form.³⁴

How to Complete Each Section

The form has five sections, A through E. Sections A and B apply to every infant. The rest apply only when the circumstances they describe come up.

Section A: Infant’s Information

Record the infant’s full name, gender, and date of birth. Below that, enter the name and phone number of the primary authorized representative, usually a parent or legal guardian, and a secondary contact. Fill this out during enrollment or on the baby’s first day in care.

Section B: Sleeping Environment Information

This section asks about how the baby sleeps at home. Note whether the infant sleeps in a crib, play yard, or another arrangement, the usual sleeping hours, the typical length of daytime naps, and whether the baby uses a pacifier (including the brand). Get this from the parent during intake. Knowing the baby’s home patterns helps you anticipate nap timing and reduces the chance of a fussy, overtired infant who fights safe positioning.

Section C: Infant’s Ability to Roll (Parent Report)

Section C comes into play once the baby can roll independently from back to stomach and back again. The authorized representative signs and dates it, confirming the milestone and when it started. Once Section C is signed, an infant who rolls on their own after being placed on their back may remain in that alternate position.³ Without a completed Section C, you must reposition the infant onto their back every time.

Section D: Infant’s Ability to Roll in Child Care (Provider Observation)

If you are the one who first observes the infant rolling independently at the facility, sign and date Section D yourself. Then have the authorized representative co-sign no later than the next business day. The two-signature requirement keeps parents informed about what their baby is doing in care and gets their agreement before the back-only rule relaxes.

Section E: Medical Exemption

Most providers check “No” and move on. Section E applies only when an infant has a written medical exemption from a licensed physician allowing an alternative sleep position. The exemption itself must spell out the specific position, how long it lasts, the physician’s contact information, and the physician’s signature and date. Attach the exemption document to the LIC 9227 and have the authorized representative sign Section E as well.

The 15-Minute Sleep Check Log

The LIC 9227 captures the plan. The 15-minute observation log is the running record you create every time that baby naps. Both center and family home providers must physically check each sleeping infant every 15 minutes.⁴ “Physically check” means walking to the crib and looking at the baby. A glance from across the room does not count.

At each check, watch for:

Labored breathing, wheezing, or unusual sounds.
Signs of distress such as flushed skin, elevated body temperature, or restlessness.
Sleep position: whether an infant under 12 months who hasn’t yet demonstrated independent rolling is still on their back.⁵

Each log entry needs the date, the infant’s name, the time of the check, and the initials of the staff person who did it.⁵ Log each check as you do it. Filling in times from memory at the end of the day is how providers end up with inconsistent records that raise red flags during inspections.

Where to Keep the Form

Completed LIC 9227 forms and their observation logs go in each child’s individual file at the facility. The records have to be available for Community Care Licensing Division evaluators during site visits.⁵ Inspections are unannounced, so keep the files organized and accessible every day you are open.

Parents and authorized representatives can also request to review these records. If an evaluator asks for sleep documentation and you cannot produce it, you have effectively admitted you either didn’t do the checks or didn’t record them.

What Noncompliance Costs

California’s citation system for child care centers starts at $50 per day, per violation, for serious deficiencies left uncorrected past the deadline in a notice of deficiency. If an infant becomes sick, is injured, or dies as a result of a deficiency, the penalty jumps immediately to $150 per day with no grace period. A repeat violation of the same regulation within 12 months triggers $150 on the first day and $50 per day after. A third offense within 12 months runs $150 per day for every day the deficiency continues.⁶

Persistent or serious violations can also lead to suspension or revocation of your facility license. The fines are modest compared to the liability exposure of an infant injury with no documentation showing you followed safe sleep protocols. A consistently completed LIC 9227 and a clean observation log are the simplest proof that you met your duty of care.

1
California Department of Social Services. Forms and Publications I-L
2
California Department of Social Services. Safe Sleep in Child Care
3
New York Codes, Rules and Regulations. California Code of Regulations Title 22 Section 101430 – Infant Care Activities
4
Cornell Law Institute. California Code of Regulations Title 22 Section 102425 – Infant Safe Sleep
5
New York Codes, Rules and Regulations. California Code of Regulations Title 22 Section 101429 – Responsibility for Providing Care and Supervision for Infants
6
Cornell Law Institute. California Code of Regulations Title 22 Section 101195 – Penalties