2014 Review Team

CHILD & FAMILY DEVELOPMENT PROGRAMS Forms Tracker 2013 - 2014 Last Updated: March 28, 2018


Enrollment/Drop Form                 

CP 2a

Child Health & Development Tracking - 45 days Development Behavioral and Growth

CP 2b

Child Health & Development Tracking - 45 days Sensory Screening

CP 2c Child Health & Development Tracking - 30 & 90 days

CP 3

Change of Status

CP 4

Child Supplemental Family Member Information  

CP 5 and definitions

Family Service Transaction Form

CP 5 a Family Service Transaction Form

CP 6

Professional Development Training Log

CP 7

Mental Health Service, Observation and Action (PIR)

CP 8

Disability Worksheet

CP 9 ERSEA Definitions

CP 13

Head Start Eligibility and Criteria Verification

CP 15 Child Plus Data Entry Procedure

Policy 1-1    

Staff Health Policy

Policy 1-2

Policy Council Fuel Stipend


Site Visit Checklist Agenda


Property Log & Inventory


Professional & Personal Development Plan

1-6 Personnel Committee Referral Form


Child Abuse and Neglect Report

Procedure 1-8 Head Start In-House Transfer Procedure


Bus Mileage

Policy 1-11

Inclement Weather Policy      English or Spanish

Policy 1-12

Child Abuse and Neglect Policy (CAN)     English or Spanish

Policy 1-13

Head Start Recruitment Policy                  English or Spanish

Procedure 1-13 Head Start Recruitment Procedure and Criteria

Policy 1-14 

Attendance Policy      English or Spanish


Intern Evaluation


Vernonia Head Start Mulit-Service Building

1-17 Application Documentation Letter    English or Spanish


Time log for Hours Away from Worksite

Policy 1-19

Students Record Policy

Policy 1-20

Client Confidentiality (Staff, Parents and Program)   English or Spanish


Long Distance Calls

Policy 1-22

Parent Reimbursement for Child Care and/or Travel

Policy 1-23

Transportation Policy for Staff


Financial Assistance Tracking Form


Personnel Information Sheet


Statement of Health

Policy 1-27

Compensation and Professional Development

Policy 1-28

Certification & Licenses


College Planning Sheet


Petty Cash Reconciliation

1-31 Required Enrollment Documents
1-31a Documents to be Shared and/or Completed
1-32 Electronic Device Checkout

Procedure 1-33

Civil Rights Complaint Procedure


Civil Rights Training Questions

Procedure 1-34

Hiring Procedure


Disbursement Voucher - fillable online or print out

1-35a Purchase Order - fillable online or print out


Bus Monitor Training Record

Policy 1-38

CAT Board & Policy Council Responsibilities

Procedure 1-39

Computer Procedure

Policy 1-40

Building Security and Key's Policy

Procedure 1-41

Procedure for Forms, Procedures and Policy Revision


Payroll Advance (Draw) Request

Procedure 1-43

Parent-Employee Guidance Procedure

Procedure 1-44

End of Year Procedure for Sending in Child Files and CACFP Menu Production Records to Rainier Admin



Procedure 1-46

Procedure for Safe Guard Star Seat Installation on the Bus

Policy 1-47   

Transportation Policy for Participants


Head Start Transportation Information


Grant Summary


Training & Technical Assistance

Policy 1-50 

Staff Children Policy

Procedure 1-51 Orientation and On-Boarding Procedure


Hiring Checklist for New Employees

1-51a Orientation Checklist for New Employees
1-51b New Staff Orientation Training Certificate
1-51c Center Norm Agenda for New Employee
1-51d Training Requirements Checklist for New Employees
1-51e Training Requirements Checklist for Center Managers
1-51f Training Requirements Checklist for Social Service
1-51g Training Requirements Checklist for Education Staff
1-51h Training Requirements Checklist for Food Service Staff
1-51i Quarterly Agenda for New Employees


Employee Action Notice

1-52a Employee Action Checklist


Plan for Improvement

Procedure 1-54

Child Arrival & Departure Procedure        English or Spanish


Recommendation for Employment

1-56 (NCR)

Purchase Order for Cook (Shopping List)

Procedure 1-56a USDA Procurement Plan

Procedure 1-57

Procedure for Contract Development


Pre-Employment Reference Form


Driver’s Daily Pre-Trip Check Sheet

Procedure 1-60

Procedure for Monitoring Child Outcomes


Evaluation Questionnaire        English or Spanish


Personal Leave Cash Out


Employee Application


Time Report


Travel Expense Statement

1-66 Key Receipt
1-68 File Review Monitoring Checklist and Program Self-Assessment Data

Form 1-70

Support and Training Review

Form 1-70 a Support and Training Reflections


Volunteer Declaration Form                  English or Spanish

1-72 Exit Interview Checklist


First Aid Supplies Checklist

Procedure 1-75

In-House Student Transfers

Procedure 1-76

Insect & Pest Control

Procedure 1-77

Procedure for Verifying Applicant Qualifications

Form 1-77a Qualification Worksheet for Teachers and Asst. Teachers

Policy 1-78

Payment for Meals                 English or Spanish

Policy 1-79

Head Start Child Care Payment Policy

Procedure 1-80

Procedure for Days of Service and Days of Class


Child's File Content Tracker

1-81a Table of Contents File Label
1-81b Education File Label
1-81c Social Service File Label
1-81d Health File Label
1-81e Special Needs File Label

Policy 1-82     

Parent/Community Grievance Policy     English or Spanish

Procedure 1-83

Technology Resource Procedure

Procedure 1-84

Procedure for Accessing a CFDP CDA Advisor


Computer Password Tracker

1-85a Password Tracker for CP, TS Gold and ASQ


Per Diem Request


Travel Reimbursement

Policy 1-88 

Non-Enrolled Participation Policy

Policy 1-89 Tobacco Free Environment          English or Spanish


Voluntary Personal Leave Transfer Request


Income Documentation for Multi-Service Building at Vernonia Head Start

Procedure 1-92

Head Start Ongoing Monitoring Procedure

Policy 1-93

Dispute Resolution

1-94 Employee Leave Request
1-95 Employee Disciplinary Action
1-96 Plan of Assistance
Procedure 1-97 USDA Non-discrimination Procedure for CACFP Compliance
Procedure 1-98 Child Health, Safety and Supervision Procedure
Procedure 1-99 Procedure for Reporting to CAT Board and Policy Council
Procedure 1-100 Procedure for Completing the Report to the Public
Procedure 1-101 Annual Professional Development Requirements Procedure
1-101a Annual Professional Development Tracking
Procedure 1-102 Educational Financial Aid Procedure
1-103 Financial Assistance Agreement
1-104 Tuition Payroll Advance Request (Full Tuition)
1-104a Tuition Assistance Request (Half of Tuition)
1-104b Financial Assistance Cover Page
1-104c CDA Credential Advance Request
1-105a Individual Training Request
Procedure 1-105 Professional Development Procedure
1-106 CDA Planning Sheet
1-107 Coaching Agreement


2-1 (a)

Monthly Lesson Plan Reqirements

2-1 (b)

Planning Observations & Individual Goals  - Weekly Planning Form (Optional)

2-1 (c) Lesson Plan Monitoring Checklist for CM  


Child Learning Profile–Interest & Goals    English or Spanish

2-2a Child Learning Profile/Interests and Strengths HS Early Learning Outcomes Framework                             English or Spanish  


About my Family                English or Spanish


Field Trip Plan Program Authorization

2-6 (NCR)

Head Start Home Visit Form                 English or Spanish

2-7 (NCR)

Individual Child Goals and Planning Form                                                    English or Spanish

2-7a Have Fun Learning Tracking Form       English or Spanish  

Procedure 2-9

Monitoring & Data Entry Guide for TS Gold

Policy 2-10

Bus and Walking Field Trips                 English or Spanish


Field Trip Notification & Permission Slip        English or Spanish

2-12 (NCR)

Home Visit Agreement                         English or Spanish

Form 2-13 Curriculum Request Form  

Policy 2-14 

Home Visit Policy                                 English or Spanish

Procedure 2-14a Home Visit Procedure
Procedure 2-15 TS Gold Checkpoint Data Analysis
2-15a TSG Checkpoint Report Analysis Summary Template

Procedure 2-16 

Procedure for Classroom Home Visits and Lesson Plan Review

Procedure 2-16a CLASS Observation Assignment Procedure  

Procedure 2-17

Procedure for Parent Teacher Conference

Guidance 2-17a

Parent Teacher Conference Guidance

2-18 (NCR)

Child Protection Unit Permission Letter      English or Spanish


Home Visit Pamphlet                            English or Spanish

2-20 Preschool Behavior Support Self Assessment  


Home Visit Forms Monitoring


Home Visit and Parent Teacher Conference Summary

Policy 2-22         

Care and Maintenance of Animals in the Center

Form 2-22a Animals in the Classroom Written Plan  

Procedure 2-23

Emergency Drill Procedure


Emergency Drill Record


Home Visit Observation Checklist


Quality Teaching and Learning Plan

Policy 2-27

Child Guidance (Staff)

Policy 2-27a

Child Guidance (Parents)                 English or Spanish


General Walking Trip Permission Slip     English or Spanish

2-29 ClassroomCheck In/Out Log for Adults and Children  


Authorization to Act as Parent               English or Spanish

2-31a Behavior Tracking Form  
2-31b Classroom Behavior Tracking Form  
2-32 Implementation Checklist Progress and Planning Form  
2-33 Staff Schedule & Active Supervision  
2-34 Support Planning Chart and Support Plan  

Procedure 2-35

School Bus Safety Education                English or Spanish

Procedure 2-36 Program-wide Positive Behavioral Intervention & Support
Procedure 2-36a Chronological Checklist for PBIS Implementation
Procedure 2-37 TS Gold Family Conference Form Procedure
2-38 Action and Behavior Plan Tracking Sheets
2-39 Permission Slip for Video for QT&L (PBC)  English or Spanish
2-40 My Teacher Wants to Know           English   or Spanish
2-41 Matrix of Classroom
Procedure 2-42 Screen Time Procedure                 English or Spanish
Procedure 2-24 sp Screen Time Procedure in Spanish
2-43 Social and Emotional Classroom Profile
2-44 PBIS Agenda for Monthly Staff Meetings
2-45 Module 3B Evaluating the Support Plan
2-46 Pre-Referral Checklist for Challenging Behaviors
2-48 Home Observation Card                English or Spanish
2-49 Observation Card
Policy 2-50 Suspension and Exclusion Policy       English or Spanish
Procedure 2-50a Suspension and Exclusion Procedure
Form 2-51 PBIS Parent Handbook                  English or Spanish


Form 3-1

Parent Preference Food Substitution

Procedure 3-2 Expectations for HSAC


Lead Checklist                                 English or Spanish


Emergency Health Concerns Tracking Form

Procedure 3-5

Referrals Procedure


Child Nutrition Screening Survey      English or Spanish


Parent/Guardian Consent to Exchange Confidential Information                                                          English or Spanish

Policy 3-8 

Medication Policy                              English or Spanish


Medication Permit and Log                English or Spanish

Policy 3-9   

Health Services Policy                      English or Spanish

Policy 3-10

Parent Request for Food and/or Milk Substitution   English or Spanish


Emergency Form                                English or Spanish

Procedure 3-13

Medication Labeling & Storage

Policy 3-14   

Management Guide for Responding to an Occupational Exposure Incident

Policy 3-15a

Policy for Dealing with Students Having a Bloodborne Pathogen

Policy 3-15b

Bloodborne Pathogens (Students)

Policy 3-15c

Bloodborne Pathogens (Staff)

Policy 3-15d

Bloodborne Pathogens Rumor Control (Staff & Students)

Policy 3-15e

Staff Accommodations (Bloodborne Pathogens)

Policy 3-15f 

Infection Control - Bloodborne Pathogens   English or Spanish

Policy 3-15g

Bloodborne Pathogens (Press/media)


Medical/Dental Items not Completed (letter to parent)                       English or Spanish

3-17 Vision Screening Form

Procedure 3-17a

Developmental and Behavior Screening and Growth Assessment

Procedure 3-17b Sensory Screening
Procedure 3-17c Health Status
Policy 3-18 Head Lice/Nits Policy                                  English or Spanish


Treatment of Headlice in the Home             English or Spanish

Policy 3-19  

Policy and Procedure for Excluding Ill Children                                                       English or Spanish


Exclusion Form                                           English or Spanish

3-19a sp  

Exclusion Form (Spanish)

3-21 (NCR)

Report of Accident to a Participant            English or Spanish


Oral Health Assessment/Dental Exam


Health Assessment/Medical Well-Child Exam

Procedure 3-24

Toothbrush Procedure


Denial of Consent for Medical - No Thank You Letter

3-25 sp   

Denial of Consent for Medical - No Thank You Letter (Spanish).

Procedure 3-26

Handwashing Procedure                          English or Spanish


Log of Injuries & Accidents

Policy 3-28

Nutrition Policy                                          English or Spanish

Procedure 3-28a       

Family Style Meal Service Procedure

Guidance 3-28b Educational Guidance for Family Style Meal Service


Food Budget Control

Proc. 3-31             

Toileting, Toileting Assistance and Diapering Procedure

3-31a Toileting Assistance and Diapering
3-31b Individual Care Toileting Plan

Policy 3-32 

Emergency Medical/Dental Action Plan


Your Child's Food Record

3-34 sp Your Child's Food Record (Spanish)


Nutrition Information Summary

Policy 3-37

Fluoride Policy

Policy 3-37 sp

Fluoride Policy (Spanish)


HSAC Contract


USDA Recipe Form


Menu Production Record


Health & Safety Log


Child & Family Health History

3-44 sp

Child & Family Health History (Spanish)

Procedure 3-45        

Sanitation Linen, Bedding & Cots


Individual Care Plan


Health Screening Letter


Asthma Information Form

3-48 sp Asthma Information Form (Spanish)
3-49 (NCR)

Cook's Point of Service Meal Count

Procedure 3-50 Infection Control Procedures (Universal Precautions)
Procedure 3-51 WIC Collection Procedure
Procedure 3-52 Cleaning, Sanitizing and Disinfecting
Form 3-53 Menu Substitution Log
Procedure 3-54 Health & Safety Checklist Procedure
3-54a Health & Safety Checklist - Teacher
3-54b Health & Safety Checklist - Center Manager
3-54c Health & Safety Checklist - Cook



Parent Committee Center Training Plan


Child Care Payment Request

Procedure  4-3

In-Kind Processing Policy


Policy Council Committee Meeting


Space Evaluation for In-Kind




In-Kind Donations and Services


Policy Council Membership Credential

Policy 4-6

Parent Activity Fund Guidelines              English or Spanish


Family Interest Survey

4-7 sp

Family Interest Survey (Spanish)


End of Year Parent Survey

4-8 sp

End of Year Parent Survey (Spanish)


CTA Application Form

4-9 sp

CTA Application Form (Spanish)


CTA Volunteer Program Placement Form English  or Spanish


CTA Monthly Work Plan   English or Spanish


Time/In-Kind Record for CTA Volunteer   English or Spanish


CTA Checklist   English or Spanish


CTA Final Evaluation    English or Spanish

Policy 4-11 

Parent Volunteer Policy

Policy 4-11 sp Parent Volunteer Policy (Spanish)
4-11a Volunteer Training      English or Spanish
4-11b CTA Program Overview       English or Spanish
Policy 4-11c Community Volunteer Policy
Policy 4-11 c sp Community Volunteer Policy (Spanish)


Policy Council 2-Way Communication Form

4-13 Policy Council Training Verification
4-14 Policy Council Confidentiality Agreement



Permission Slip for Children

5-1 sp

Permission Slip for Children (Spanish)


Contact Sheet

5-2a Notice of Family Contact
5-3 TANF RV letter                       English      Spanish


Family Plan and Goal Sheet

5-4 sp

Family Plan and Goal Sheet (Spanish)


Head Start Child Application

5-6 sp

Head Start Child Application (Spanish)


Policy Council Meeting Notes


Enrollment Drop Letter

5-9 sp

Enrollment Drop Letter (Spanish)




Signature Sheet for SOAP Files


SOAP Table of Contents

5-10c Family Staffing

5-11 (NCR)

Staffing Recording/Staff Meeting Minutes/Site Visit Monitoring

5-11 (for computer) Staff Record/Staff Meeting Minutes you can use computer to fill out
5-11a CLASS Debrief


Self Declaration Form

5-12 sp

Self Declaration Form (Spanish)


Referral for Mental Health Counseling

5-13 sp Referral for Mental Health Counseling (Spanish)

Procedure 5-14

SOAP File Set-Up Procedure

Procedure 5-15 Verification of Training and Eligibility Requirements


Absentee Follow-up Report


Selection Letter

5-17 sp

Selection Letter (Spanish)


Full Enrollment Waitlist Letter

5-18 sp

Waiting List Letter (Spanish)

5-18a Pre-Selection Waitlist Letter                  English     Spanish


Second Year Welcome Letter

5-19 sp

Second Year Welcome Letter (Spanish)


Income Verification Letter - Child Support

5-20 sp

Income Verification Letter - Child Support (Spanish)

5-20 a

Income Verification Letter - Foster

5-20 a sp

Income Verification Letter - Foster (Spanish)


TANF Income Verification Letter

5-21 sp

TANF Income Verification Letter (Spanish)

Procedure 5-22

Court Procedure & Information Disclosure


Transition Meeting Summary

Policy 5-26

Transition Policy

Procedure 5-26a

Transition to Kindergarten Procedure


Parent Gas Stipend

5-27 sp

Parent Gas Stipend (Spanish)

Procedure 5-28 Reciprocal Relationship - Family Partnership Process
5-28a Family Needs, Interest & Strengths Assessment
5-28a sp Family Needs, Interest & Strengths Assessment in Spanish
Guidance 5-28b Scaled Family Assessment Tool Guidance
Form 5-29 Selection Letter Notification sent to Case Worker
5-30 Intent to Re-Enroll


Parent Gas Stipend

5-65 sp Parent Gas Stipend (Spanish)

Policy 5-66

Parent Gas Stipend Policy

Policy 5-66 sp Parent Gas Stipend Policy ( Spanish)


Procedure 6-2 Recruitment, Referral, Selection and Services for Children with Diagnosed Disabilities
6-8 Scale for Teacher's Assessment of Routines Engagement


Parent Permission for Mental Health Observation & Classroom Planning                                          English          Spanish


Letter to Parent Introduction to Mental Health Services     

                                                       English             Spanish

6-11 Mental Health Staffing
6-11a Mental Health Debriefing



Die Cut Request Form


Boardmaker Request Form



Director/Sub Director Orientation & Training Documentation for CCD




Area Supervisor

Assistant Teacher

Associate Director

Bilingual Assistant

Bilingual Assistant for Healthy Families

Building Manager     

Bus Driver

Bus Monitor

Center Manager        

Child Care Provider


Court Parenting Specialist



Disabilities Specialist
Education Specialist
Family Advocate

Family Engagement Support

Floating Aide

Healthy Families Home Visitor

Healthy Families Program Manager

MIECHV Healthy Families Supervisor
Mental Health Consultant

Office Support Assistant

Office Support Specialist

Parent Educator/Home Visitor

Parent Support Coordinator

Parent Educator

Prep Cook


Traveling Teacher

Work Study Assistant



PBIS Forms:

     NHSA Scholarships and OHSA Scholarships
     Self Reliance Tracker

     Head Start Informational Brochure in English and Spanish

     USDA Enrollment Form in English and Spanish

  CCDC Questions, Answers and Definitions

     CFDP Letterhead

     1 Year HS Child Participation - English and Spanish

     2 Year HS Child Participation - English and Spanish

     Parent/Guardian Participation - English and Spanish

     Volunteer - English and Spanish

     Program Training for New Staff

     School Readiness Curriculum Guide

     School Readiness Goals for Teachers
     Form 2-1c Interest Area Guidance
     Form 2-1d Lesson Plans Details for Week 1
     Form 2-1d Lesson Plans Summary for Week 1
     Form 2-1e Lesson Plans Details for Week 2
     Form 2-1e Lesson Plans Summary for Week 2
     Form 2-1f Lesson Plans Details for Week 3
     Form 2-1f Lesson Plans Summary for Week 3
     School Readiness Goals in English and Spanish

     Vision/Mission Statement

     Income Guidelines for Head Start

     Parent Handbook in English and Spanish

     CTA Volunteer Manual
     CTA Volunteer Handbook in English and Spanish
     CTA - Interviewing and Placing
     Bus Observation for Center Manager
     Center Manager Declaration of Understanding
     CIGNA Insurance Booklet
     Integrated Work Plan
     2014-2016 Community Assessment Update
     Class Observation Assignment for 2015-2016
     Dates Due Page for 2016-2017
     ERSEA Tracking Form
     2016-2017 Program Year Calendar
     T & TA Plan


Performance Appraisals

Area Supervisor

Assistant Teacher
Associate Director
Bilingual Assistant
Bilingual Assistant for Healthy Start
Building Manager
Bus Driver
Bus Monitor
Center Manager
Center Volunteer
Court Parenting Specialist
Family Advocate
Family Worker
Floating Aide
Healthy Families Home Visitor
Healthy Families Program Manager
Nutrition Aide
Office Support
Office Support Specialist
Parent Educator
Parent Support Coordinator
Prep Cook
Work Study Assistant


Healthy Start Manager Forms

ASQ Tracking Table

HFA Standard for Training Topics

Training Tracker - Cross Walk - HFA to TT Codes


FSW Forms


State Healthy Start Forms can be found here: www.oregon.gov/OCCF/webapps.shtml