CHILD & FAMILY DEVELOPMENT PROGRAMS Forms Tracker 2011 - 2012 Last Updated: February 3, 2012
CP1

Enrollment/Drop Form

CP 2a

Child Health & Development Tracking - 45 days

CP 2b

Child Health & Development Tracking - 90 days

CP 3

Change of Status

CP 4

Child Supplemental Family Member Information  

CP 5

Family Service Transaction Form

CP 6

Training Evaluation Log

CP 7

PIR Addendum Questions

CP 8

Disability Worksheet

CP 11

Mental Health

CP 13

Eligibility Priority Criteria

CP 15 Child Plus Data Management
   
   

Policy 1-1    

Staff Health Policy

Policy 1-2

Policy Council Fuel Stipend

1-3

Site Visit Checklist Agenda

1-4

Property Log & Inventory

1-5

Professional & Personal Development Plan

1-6

Communication Checklist

1-7

Child Abuse and Neglect Report

Policy 1-8 

Training Sharing Policy

Policy 1-8 sp

Training Sharing Policy in Spanish

Policy 1-9 

Health and Safety Policy

Policy 1-9 sp Health and Safety Policy in Spanish

1-10

Bus Mileage

Policy 1-11

Inclement Weather Policy

Policy 1-11 sp

Inclement Weather Policy in Spanish

Policy 1-12

Child Abuse and Neglect Policy (CAN)

Policy 1-12 sp

Child Abuse and Neglect in Spanish

Policy 1-13

Recruitment Policy and Criteria

Policy 1-13 sp

Recruitment Policy & Criteria in Spanish

Policy 1-14 

Enrollment & Attendance Policy

Policy 1-14 sp

Attendance in Spanish

1-15

Intern Evaluation

1-16

Vernonia Head Start Mulit-Service Building

1-17

Performance Appraisal Conference Form

1-18

Time log for Hours Away from Worksite

Policy 1-19

Child Education Record Policy

Policy 1-20

Client Confidentiality (Program)

Policy 1-20a

Client Confidentiality (Volunteer)

Policy 1-20a sp

Spanish version of Client Confident.

1-21

Long Distance Calls

Policy 1-22

Parent Reimbursement Child Care and/or Travel

Policy 1-23

Transportation Policy for Staff

1-24

Financial Assistance Form

1-25

Personnel Information Sheet

1-26  

Staff Medical Statement of Health

Policy 1-27

Compensation and Professional Development

Policy 1-28

Certification & Licenses

Policy 1-29  

Professional Advance Policy

1-29a

College Planning Sheet

1-30

Petty Cash Reconciliation

1-32

Staff Conference Form

Procedure 1-33

Civil Rigths Complaint Procedure

1-33a

Civil Rights Training Questions

Procedure 1-34

Hiring Procedure

1-35

Disbursement Voucher

1-36

Bus Monitor Training Record

1-37

CAT Accident Investigation Report

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

1-42

Payroll Advance (Draw) Request

Procedure 1-43

Parent-Employee Guidance

Procedure 1-44

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

1-45

Training Evaluation

Procedure 1-46

Procedure for Safe Guard Start Seat Installation on the Bus

Policy 1-47   

Transportation Policy for Participants

1-47a                  

Head Start Transportation Information (Pick Up/Drop Off)

1-48

Grant Summary

1-49

Training & Technical Assistance

Policy 1-50 

Staff Children Policy

1-51

Employee Action Checklist

1-52

Employee Action Notice

1-53

Plan for Improvement

Procedure 1-54

Child Arrival & Departure Procedure

1-54a       

Classroom Daily Check In/Out Log

1-55

Recommendation for Employment

1-56 (NCR)

Purchase Order for Cook (Shopping List)

Procedure 1-57

Procedure for Contract Development

1-58

Pre-Employment Reference Form

1-59

Driver’s Daily Pre-Trip Check Sheet

Procedure 1-60

Procedure for Monitoring Child Outcomes

1-61

Evaluation Questionnaire

1-61 sp Evaluation Questionnaire in Spanish

1-62

CAT Personal Leave Cash Out Form

1-63

Employee Application

1-64

Time Report

1-65

Travel Expense Statement

1-66 Key Receipt (for Buildings)

Procedure 1-67

Procedure for Maintaining Child Plus Data Entry
1-68 Area supervisor's File Review Monitoring Checklist and Program Self-Assessment Data

Policy 1-69

Policy for Hiring Substitute Center Staff Person

Policy 1-69 sp

Spanish version of 1-69

Form 1-70

Performance Appraisal Review at 4 and 8 Months

1-71

Volunteer Declaration Form

1-71 sp

Spanish Volunteer Declaration form

1-72 Exit Interview Checklist

Procedure 1-73

Procedure for Addressing Program Concerns

1-74   

First Aid Supplies Checklist

Procedure 1-75

In-House Student Transfer

Procedure 1-76

Insect & Pest Control

Procedure 1-77

Procedure for Verifying Applicant Qualifications

Policy 1-78

Payment for Meals

Policy 1-78 sp

Spanish Payment for Meals

Policy 1-79

Head Start Child Care Payment Policy

Procedure 1-80

Procedure for Days of Service and Days of Class

1-81

Sign-In Sheet for Child’s File

Procedure 1-82     

Parent/Community Grievance

Policy 1-82 sp

Spanish version of Parent Grievance

1-83

Confidentiality of Computer and Network Resources Assurance Statement

Procedure 1-84

Accessing CFDP CDA Advisor

1-85

Computer Password Tracker

1-86

Per Diem Request

1-87

CAT Travel Reimbursement

Policy 1-88 

Siblings in the Classroom

Policy 1-89 Tobacco Free Environment
Policy 1-89 sp Tobacco Free Environment in Spanish

1-90

Voluntary Personal Leave Transfer Request

1-91

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
Form 1-101 Teacher Training Hours Declaration of Understanding and Tracking Form
 

 

2-1 (c)

Lesson Plan – Weekly Planning

2-1 (d)

Lesson Plan form D – Individual Goals

2-2

Child Learning Profile–Interest & Goals

2-2 sp Child Learning Profile-Interest & Goals in Spanish
2-3 CCDC Questions 51 & 52

2-4

About my Family

2-4 sp

About my Family

2-5

Field Trip Plan Authorization

2-5a                   

Field Trip Report

2-6 (NCR)

Home Visit

2-6 sp (NCR)

Spanish version of Home Visit

2-7 (NCR)

Individual Child Planning

2-7 sp (NCR)

Spanish version of Individual Planning

Procedure 2-8

DECA Documentation and Level Planning Procedure

Procedure 2-9

Monitoring & Data Entry Guide Procedure for CCDC and CCNet

Policy 2-10

Field Trip

2-11

Specific Field Trip Permission Slip

2-11 sp

Specific Field Trip Permission (Span)

2-12 (NCR)

Home Visit Agreement Letter

2-12 sp (NCR)

Spanish Home Visit Agreement Letter

Procedure 2-13 Health/Safety Checklist Procedure  

2-13a

Health/ Safety Checklist (Teachers)

2-13b

Health/Safety Checklist (CM)

2-13c

Health/Safety Checklist (Cooks)

Policy 2-14 

Home Visit Policy

Policy 2-14 sp

Spanish Home Visit Policy

Procedure 2-16 

Classroom Observation

Procedure 2-17

Parent Teacher Conference Guidance

Guidance 2-17a

Parent Teacher Conference Guidance

2-18 (NCR)

Talk about Touching Letter

2-18 sp (NCR)

Spanish Talk about Touching Letter

2-19

Home Visit Pamphlet

2-19 sp

Spanish Home Visit Pamphlet

2-20

Notice of Family Contact

2-21

Home Visit Evaluation

2-21a

Home Visit Summary

Policy 2-22         

Animals in the Classroom

Procedure 2-23

Bus Evacuation Procedure

2-24

Fire Drill Observation/Evaluation

2-24a

Earthquake Drill

2-24b

Bus Evacuation Drill

2-25

Home Visit Observation Checklist

2-26

ECERS Technical Assistance Plan

Policy 2-27

Child Discipline (Staff)

Policy 2-27a

Child Discipline (Parents)

Policy 2-27a sp

Parents Spanish form

2-28

General Walking Trip Permission Slip

2-28 sp

Spanish General Walking Permission Slip

Procedure 2-29

Data Entry Guide for CCDC Class Summary Worksheet

2-30

Authorization to Act as Parent

2-30 sp

Spanish Auth. To Act as Parent

Procedure 2-35

School Bus Safety Education

Procedure 2-35 sp

School Bus. Safety Education

 

3-1 (NCR)

Ouch Form

3-1 sp (NCR)

Spanish Ouch Form

Procedure 3-2  

Expectations for HSAC

3-3

Lead Checklist

3-3 sp

Spanish Lead Checklist

3-4

Emergency Health Concerns Tracking Form

Procedure 3-5

Referrals Procedure

3-6

Child Nutrition Screening Survey

3-6 sp

Nutrition Survey in Spanish

3-7

Parent/Guardian Consent to Exchange Confidential Information

3-7 sp

Spanish Version of 3-7

Policy 3-8 

Medication Policy

Policy 3-8 sp

Spanish Version of 3-8

3-8a

Medication Permit and Log

3-8a sp

Medication Permit in Spanish

Policy 3-9   

Health Services Policy

Policy 3-9 sp 

Spanish Health Services Policy

Policy 3-10

Parent Request for Food Substitution

Policy 3-10 sp

Request for Food Substitution in Spanish

3-11

Emergency Form

3-11 sp

Spanish Emergency Form

3-12

Medical Statement for Food Substitution.

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 Bloodborne Pathogens

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

Policy 3-15f sp

Infection Control - Spanish

Policy 3-15g

Bloodborne Pathogens (Press/media)

3-16

Medical/Dental Items not Completed (letter to parent)

Procedure 3-17

Health Status and Screening Guide

3-17a Vision Screening Form

Policy 3-18 

Head Lice/Nits Policy

Policy 3-18 sp

Head Lice/Nits Policy in Spanish

3-18a

Treatment of Headlice in the Home

3-18a sp

Treatment of Headlice Spanish ver.

Policy 3-19  

Policy and Procedure for Excluding Ill Children

Policy 3-19 sp

Spanish Exclusion of Child. From Attn.

3-19a

Exclusion Form

3-19a sp  

Spanish Exclusion

Procedure 3-20

Yearly Screening Guidance

3-21

Report of Accident to a Participant

3-22

Dental Statement

3-23

Health Statement Documentation

Procedure 3-24

Toothbrush Procedure

3-25        

Denial of Consent for Medical

3-25 sp   

Spanish Denial of Consent for Med.

Procedure 3-26

Handwashing Procedure

3-27

Log of Injuries & Accidents

Policy 3-28

Nutrition Policy

Procedure 3-28a       

Family Style Meal Service Procedure

3-29

Food Budget Control

Policy 3-30

Medical Home Policy

Proc. 3-31             

Toileting, Toileting Assistance and Diapering Procedure

Policy 3-32 

Emergency Medical/Dental Action

3-34

Your Child's Food Record

3-34 sp Your Child's Food Record in Spanish

3-36

Nutrition Information Summary

Policy 3-37

Fluoride Policy

Policy 3-37 sp

Fluoride Policy in Spanish

3-38

HSAC Contract

3-40

USDA Recipe Form

3-41

Menu Production Record

Procedure 3-42

Assisting Families with Health Services and Documentation

3-43

Health & Safety Log

3-44

Child Health History

3-44 sp

Child Health History - Spanish

Procedure 3-45        

Sanitation Linen, Bedding & Cots

3-46

Individual Care Plan

3-47

Health Screening Letter

3-47 sp

Health Screening Letter in Spanish

3-48

Asthma Information Form

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

Cook's Point of Service Meal Count

Procedure 3-50 Universal Precaution Procedure

  

4-1

Parent Committee Center Training Plan

4-2

Child Care Payment Request

Procedure  4-3

In-Kind Processing Policy

4-3a

Policy Council Committee Meeting

4-3b

Space Evaluation for In-Kind

4-3c   

In-Kind

4-3e

In-Kind Donations and Services

4-4

Policy Council Membership Credential

4-5

Procedure for Maintaining a Working Relationship with SCF and Community Agencies

Policy 4-6

Parent Activity Fund Guidelines

4-7

Family Interest Survey

4-7 sp

Spanish Family Interest Survey

4-8

End of Year Parent Survey

4-8 sp

End of Year Survey in Spanish

4-9

CTA Application Form

4-9 sp

CTA Application in Spanish

4-9a

CTA Volunteer Program Placement Form

4-9b

CTA Monthly Work Plan

4-9c

Time/In-Kind Record for CTA Volunteer

4-9d

CTA Checklist

4-9e

CTA Final Evaluation

4-10

Social Service Observation Form

Policy 4-11 

Parent Volunteer Policy

Policy 4-11 sp Parent Volunteer Policy in Spanish
4-11a Volunteer Training
4-11b CTA Program Overview
Policy 4-11c Community Volunteer Policy
Policy 4-11 c sp Community Volunteer Policy in Spanish

4-12

Policy Council 2-Way Communication Form

4-13 Policy Council Training Verification

 

5-1

Permission Slip for Children

5-1 sp

Spanish version of Permission Slip

5-2

Contact Sheet

5-3a

Family Interest Resource Book List

5-4  

Family Goal Worksheet

5-4 sp

Spanish Family Goal Worksheet

5-5

Media Permission Slip

5-5 sp

Media Permission Slip in Spanish

5-6

Child Application

5-6 sp

Spanish Version of 5-6

5-6a

Head Start Eligibility Verification

Procedure 5-7

Procedure for Maintaining Working Relationship with CSD and Community Agencies

5-8

Policy Council Minutes Notes

5-9

Drop Form

5-9 sp

Spanish Version of 5-9

5-10

SOAP

5-10a

Signature Sheet for SOAP Files

5-10b

SOAP Table of Contents

5-11 (NCR)

Staffing Record/Staff Meeting Minute

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

5-12

Self Declaration Form

5-12 sp

Spanish Version of 5-12

5-13

Referral for Mental Health Counseling

5-13 sp Spanish Version of 5-13

Procedure 5-14

Child File Set-Up

Procedure 5-15 Verification of Training and Eligibility Requirements

5-16

Absentee Follow-up Report

5-17

Selection Letter

5-17 sp

Spanish Version of 5-17

5-18

Waiting List Letter

5-18 sp

Spanish Version of 5-18

5-19

Second Year Welcome Letter

5-19 sp

Spanish 2nd Year Welcome Letter

5-20

Income Verification Letter - Child Support

5-20 sp

Spanish Income Verification Letter - Child Support

5-20 a

Income Verification Letter - Foster

5-20 a sp

Spanish Income Verification Letter - Foster

5-21

TANF Income Verification Letter

5-21 sp

Spanish TANF Income Verification Letter

Procedure 5-22

Court Procedure & Information Disclosure

5-23 (NCR) Head Start Social Service Home Visit Form
5-23sp (NCR) Social Service Home Visit in Spanish

5-24

Transition Meeting Summary

5-25 Social Service Home Visit Summary

Policy 5-26

Transition Policy

Procedure 5-26a

Transition to Kindergarten

5-27

Parent Gas Stipend

5-27 sp

Spanish Parent Gas Stipend

Procedure 5-28 Family Partnership Agreement Procedure

5-65

Parent Gas Stipend

5-65 sp Parent Gas Stipend in Spanish

Policy 5-66

Parent Gas Stipend Policy

Policy 5-66 sp Parent Gas Stipend Policy in Spanish

 

6-1

Parent Notification of IEP Meeting

Procedure 6-2 Referral & Selection of Children with Diagnosed Disabilities

6-9

Parent Permission for Evaluation

6-10

Diagnostic or Interim IEP

  

8-1

Die Cut Request Form

8-2

Boardmaker Request Form

 

 

JOB DESCRIPTION

Area Supervisor

Assistant Teacher

Associate Director

Bilingual Assistant

Bilingual Assistant for Healthy Start

Building Manager     

Bus Driver

Bus Monitor

Center Manager        

Child Care Provider

Cook

Court Parenting Specialist

Custodian

Director

Family Advocate

Family Worker

Floating Aide

Healthy Start Home Visitor

Healthy Start Program Manager

Office Support

Office Support Specialist

Parent Educator/Home Visitor

Parent Support Coordinator

Parent Educator

Prep Cook

Teacher              

Traveling Teacher

Work Study Assistant

 
 

MISCELLANEOUS FORMS

PBIS Forms:

    
     
     PBIS Book in Spanish
          
     Home Observation Card
     Home Visit Observation Card in Spanish
     Observation Card
     Fall Pre-Set Action Plan Summary
     Behavior Tracking Form
     Data Collection Sheet
     Evaluating Support Plan
     Support Planning Chart
     Self Sufficiency 2011
     Self Reliance Tracker
     Income Change Form
     Blank Removal from Dependency Form

Blue Flyer

Blue Flyer - Spanish

CCDC Questions, Answers and Definitions

CFDP Letterhead

1 Year HS Child Participation - English

1 Year HS Child Participation - Spanish

2 Year HS Child Participation - English

2 Year HS Child Participation - Spanish

Parent/Guardian Participation - English

Parent/Guardian Participation - Spanish

Volunteer - English

Volunteer - Spanish

Menus

Curriculum Supplement and School Readiness Guide

Vision/Mission Statement

Integrated Work Plan

Income Guidelines for Head Start

Parent Handbook in English

Parent Handbook in Spanish

CTA Volunteer Manual
CTA Volunteer Handbook
CTA Volunteer Handbook in Spanish
CTA - Interviewing and Placing
CFDP School Readiness Goals
Lesson Plan Monitoring Checklist for Center Managers

 

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
Cook
Court Parenting Specialist
Custodian
Director
Family Advocate
Family Worker
Floating Aide
Healthy Start Family Assessment & Support Worker
Healthy Start Program Manager
Nutrition Aide
Office Support
Office Support Specialist
Parent Support Coordinator
Prep Cook
Teacher
Work Study Assistant

 

Healthy Start Manager Forms

ASQ Tracking Table
 
 

 

FSW Forms

 

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