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(g) Written evidence from a physician or health resource attesting that each person is free from communicable tuberculosis at the time of licensure or registration and subsequently according pursuant to state statute or the South Carolina Department of Health and Environmental Control regulations or policy; and (h) A health assessment from a health care provider assessing the ability of the operator/caregiv- er to work with children. The health assessment shall be completed within three months prior to licensure, registration or employment or within the first month of licensure, registration or employment and shall include health history, physical exam, vision and hearing screening, tuberculosis screening, and a review of immunization status, and a discussion regarding recom- mended vaccinations, including a one-time adult dose of TDAP. A new health assessment shall be obtained by the operator/caregiver at least every four years after the initial assessment. H. Training (1) All caregivers shall participate in at least ten (10) clock hours of training annually. At least four (4) clock hours shall be in child growth and development. If serving infants 12 months and under, one hour of safe sleep is required. The remaining hours shall come from the following areas: program administration, safety, health, nutrition, physical activity, guidance, infant/child CPR and first aid, and Blood Borne Pathogen training or other areas approved by the Department. (2) Caregivers who receive training in excess of ten (10) hours per year may carry five (5) of those hours to the following year in the category earned. HISTORY: Added by SCSR 48–5 Doc. No. 5229, eff May 24, 2024. 114–533. Program. A. Supervision Supervision of children shall be adequate at all times and requires: (1) Awareness and responsibility for the ongoing activity of each child, knowledge of activity requirements and children’s needs and accountability of care. (2) The operator and/or caregiver is in the same general area as the children and immediately available to them at all times. (3) The operator and/or caregiver is directly overseeing the children and their activities at all times. (4) The operator and/or caregiver is monitoring all of the children’s activities by sight. (5) The operator and/or caregiver is outside with all children in care during outdoor play. B. Naptime Supervision (1) The operator and/or caregiver is awake and alert while the children nap. (2) The operator and/or caregiver is on the same level of the home where the children are napping. (3) The operator and/or caregiver keeps all doors open if children nap in different rooms or areas. (4) The operator and/or caregiver visually checks on each child every fifteen (15) minutes. (5) The operator and/or caregiver shall be accessible to the children during naptime in case they have an emergency, i.e. asthma attack, breathing stops, or any other traumatic experience or in case of an emergency situation that requires evacuation, such as a fire. C. Number of children in the home (1) The operator may have up to six (6) children in the home at any given time, including children living in the home and children related to the operator who are under the age of twelve (12), unless zoning restrictions further limit the number of children. (2) There shall be an additional caregiver, household member eighteen (18) years of age or older, staff, emergency person, or volunteer on the premises when four or more children in attendance are younger than twelve (12) months of age. D. Attendance