2014 Review Team

CHILD & FAMILY DEVELOPMENT PROGRAMS Forms Tracker 2013 - 2014 Last Updated: April 10, 2014

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 9 ERSEA Definitions

CP 11

Mental Health

CP 13

Eligibility Priority Criteria

CP 15 Child Plus Data Entry Procedure
   
   

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 Personnel Committee Referral Form

1-7

Child Abuse and Neglect Report

Procedure 1-8 Head Start In-House Transfer Procedure

Policy 1-9 

Health and Safety Policy

Policy 1-9 sp Health and Safety Policy ( Spanish)

1-10

Bus Mileage

Policy 1-11

Inclement Weather Policy

Policy 1-11 sp

Inclement Weather Policy (Spanish)

Policy 1-12

Child Abuse and Neglect Policy (CAN)

Policy 1-12 sp

Child Abuse and Neglect Policy (Spanish)

Policy 1-13

Head Start Recruitment Policy and Criteria

Policy 1-13 sp

Head Start Recruitment Policy and Criteria (Spanish)

Policy 1-14 

Enrollment & Attendance Policy

Policy 1-14 sp

Enrollment & Attendance Policy (Spanish)

1-15

Intern Evaluation

1-16

Vernonia Head Start Mulit-Service Building

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/Parent)

Policy 1-20a sp

Client Confidentiality (Volunteer/Parent) (Spanish)

1-21

Long Distance Calls

Policy 1-22

Parent Reimbursement for Child Care and/or Travel

Policy 1-23

Transportation Policy for Staff

1-24

Financial Assistance Tracking Form

1-25

Personnel Information Sheet

1-26  

Statement of Health

Policy 1-27

Compensation and Professional Development

Policy 1-28

Certification & Licenses

1-29a

College Planning Sheet

1-30

Petty Cash Reconciliation

1-32

Staff Conference Form

1-31 College Expense Special Request Form

Procedure 1-33

Civil Rigths Complaint Procedure

1-33a

Civil Rights Training Questions

Procedure 1-34

Hiring Procedure

1-35

Disbursement Voucher - fillable online or print out

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

1-36

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

1-42

Payroll Advance (Draw) Request

Procedure 1-43

Parent-Employee Guidance Procedure

Procedure 1-44

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

1-45

Evaluation

Procedure 1-46

Procedure for Safe Guard Star Seat Installation on the Bus

Policy 1-47   

Transportation Policy for Participants

1-47a                  

Head Start Transportation Information

1-48

Grant Summary

1-49

Training & Technical Assistance

Policy 1-50 

Staff Children Policy

1-51

Orientation Checklist for New Employees

1-51a 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 (Spanish)

1-62

Personal Leave Cash Out

1-63

Employee Application

1-64

Time Report

1-65

Travel Expense Statement

1-66 Key Receipt
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

Policy for Hiring Substitute Center Staff Person (Spanish)

Form 1-70

Support and Training Review

Form 1-70 a Support and Training Reflections

1-71

Volunteer Declaration Form

1-71 sp

Volunteer Declaration Form (Spanish)

1-72 Exit Interview Checklist

1-74   

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

Policy 1-78

Payment for Meals

Policy 1-78 sp

Payment for Meals (Spanish)

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

Policy 1-82     

Parent/Community Grievance Policy

Policy 1-82 sp

Parent/Community Grievance Policy (Spanish)

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

Travel Reimbursement

Policy 1-88 

Non-Enrolled Participation Policy

Policy 1-89 Tobacco Free Environment
Policy 1-89 sp Tobacco Free Environment (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 15 Hours Teacher Training Declaration of Understanding and Tracking Form
Procedure 1-102 Educational Financial Aid Procedure
1-103 Financial Assistance Agreement
1-104 Tuition Payroll Advance Request
Procedure 1-105 Sharing Training Procedure and Individual Training Request Form
1-106 CDA Planning Sheet
 

 

2-1 (c)

Monthly Planning Form

2-1 (d)

Weekly Planning Form

2-2

Child Learning Profile–Interest & Goals

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

2-4

About my Family

2-4 sp

About my Family (Spanish)

2-5

Field Trip Plan Program Authorization

2-5a                   

Head Start Field Trip Report

2-6 (NCR)

Head Start Home Visit Form

2-6 sp (NCR)

Head Start Home Visit Form (Spanish)

2-7 (NCR)

Individual Child Planning Form

2-7 sp (NCR)

Individual Child Planning Form (Spanish)

Procedure 2-8

DECA Documentation and Level Planning Procedure

Procedure 2-9

Monitoring & Data Entry Guide Procedure for CCDC and CCNet

Policy 2-10

Bus and Walking Field Trips

2-11

Specific Field Trip Permission Slip

2-11 sp

Specific Field Trip Permission (Spanish)

2-12 (NCR)

Home Visit Agreement

2-12 sp (NCR)

Spanish Home Visit Agreement

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 & Custodians)

Policy 2-14 

Home Visit Policy

Policy 2-14 sp

Home Visit Policy (Spanish)

Guidance 2-15 Teaching Strategies Gold (TSG) Report Analysis

Procedure 2-16 

Procedure for Classroom Home Visits and Lesson Plan Review

Procedure 2-17

Procedure for Parent Teacher Conference Guidance

Guidance 2-17a

Parent Teacher Conference (PTC) Guidance

2-18 (NCR)

Talk about Touching Letter

2-18 sp (NCR)

Talk about Touching Letter (Spanish)

2-19

Home Visit Pamphlet

2-19 sp

Home Visit Pamphlet (Spanish)

2-20

Notice of Family Contact

2-21

Home Visit Forms Evaluation

2-21a

Home Visit Summary

Policy 2-22         

Care and Maintenance of Animals in the Classroom

Procedure 2-23

Bus Evacuation Procedure

2-24

Fire Drill Observation/Evaluation

2-24a

Earthquake Drill Observation/Evaluation

2-24b

Bus Evacuation Drill Observation/Evaluation

2-25

Home Visit Observation Checklist

2-26

ECERS Technical Assistance Plan

Policy 2-27

Child Guidance (Staff)

Policy 2-27a

Child Guidance (Parents)

Policy 2-27a sp

Child Guidance Parents (Spanish)

2-28

General Walking Trip Permission Slip

2-28 sp

General Walking Trip Permission Slip (Spanish)

2-30

Authorization to Act as Parent

2-30 sp

Authorization to Act as Parent (Spanish)

2-32 Implementation Checklist Progress and Planning Form  
2-34 PBIS Action Plan (Tier II)  
Example 2-34 Filled out example of Form 2-34  

Procedure 2-35

School Bus Safety Education

Procedure 2-35 sp

School Bus Safety Education (Spanish)

Procedure 2-36 Program-wide Positive Behavioral Intervention & Support
Procedure 2-37 TS Gold Family Conference Form Procedure
2-38 Action and Behavior Plan Tracking Sheets

 

3-1 (NCR)

Ouch Band-Aids and Hugs Form

3-1 sp (NCR)

Ouch Band-Aids and Hugs Form (Spanish)

Procedure 3-2  

Expectations for HSAC

3-3

Lead Checklist

3-3 sp

Lead Checklist (Spanish)

3-4

Emergency Health Concerns Tracking Form

Procedure 3-5

Referrals Procedure

3-6

Child Nutrition Screening Survey

3-6 sp

Nutrition Survey (Spanish)

3-7

Parent/Guardian Consent to Exchange Confidential Information

3-7 sp

Parent/Guardian Consent to Exchange Confidential Information (Spanish)

Policy 3-8 

Medication Policy

Policy 3-8 sp

Medication Policy (Spanish)

3-8a

Medication Permit and Log

3-8a sp

Medication Permit (Spanish)

Policy 3-9   

Health Services Policy

Policy 3-9 sp 

Health Services Policy (Spanish)

Policy 3-10

Parent Request for Food Substitution

Policy 3-10 sp

Parent Request for Food Substitution (Spanish)

3-11

Emergency Form

3-11 sp

Emergency Form (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

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 (Spanish)

3-18a

Treatment of Headlice in the Home

3-18a sp

Treatment of Headlice in the Home (Spanish)

Policy 3-19  

Policy and Procedure for Excluding Ill Children

Policy 3-19 sp

Policy and Procedure for Excluding Ill Children (Spanish)

3-19a

Exclusion Form

3-19a sp  

Exclusion Form (Spanish)

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 - No Thank You Letter

3-25 sp   

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

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 Plan

3-34

Your Child's Food Record

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

3-36

Nutrition Information Summary

Policy 3-37

Fluoride Policy

Policy 3-37 sp

Fluoride Policy (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 & Family Health History

3-44 sp

Child & Family 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 (Spanish)

3-48

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

  

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

Family Interest Survey (Spanish)

4-8

End of Year Parent Survey

4-8 sp

End of Year Parent Survey (Spanish)

4-9

CTA Application Form

4-9 sp

CTA Application Form (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 (Spanish)
4-11a Volunteer Training
4-11b CTA Program Overview
Policy 4-11c Community Volunteer Policy
Policy 4-11 c sp Community Volunteer Policy (Spanish)

4-12

Policy Council 2-Way Communication Form

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

 

5-1

Permission Slip for Children

5-1 sp

Permission Slip for Children (Spanish)

5-2

Contact Sheet

5-4  

Family Plan and Goal Sheet

5-4 sp

Family Plan and Goal Sheet (Spanish)

5-6

Child Application

5-6 sp

Child Application (Spanish)

5-6a

Head Start Eligibility Verification

Procedure 5-7

Procedure for Maintaining Working Relationship with CSD and Community Agencies

5-8

Policy Council Meeting Notes

5-9

Drop Form

5-9 sp

Drop Form (Spanish)

5-10

SOAP

5-10a

Signature Sheet for SOAP Files

5-10b

SOAP Table of Contents

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

5-12

Self Declaration Form

5-12 sp

Self Declaration Form (Spanish)

5-13

Referral for Mental Health Counseling

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

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

Selection Letter (Spanish)

5-18

Waiting List Letter

5-18 sp

Waiting List Letter (Spanish)

5-19

Second Year Welcome Letter

5-19 sp

Second Year Welcome Letter (Spanish)

5-20

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)

5-21

TANF Income Verification Letter

5-21 sp

TANF Income Verification Letter (Spanish)

Procedure 5-22

Court Procedure & Information Disclosure

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

5-24

Transition Meeting Summary

5-25 Social Service Home Visit Summary

Policy 5-26

Transition Policy

Procedure 5-26a

Transition to Kindergarten Procedure

5-27

Parent Gas Stipend

5-27 sp

Parent Gas Stipend (Spanish)

Procedure 5-28 Family Partnership Agreement Procedure
5-28a Scaled Family Assessment Tool
Guidance 5-28b Scaled Family Assessment Tool Guidance
Form 5-29 Selection Letter Notification sent to Case Worker

5-65

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

6-9

Parent Permission for Evaluation

  

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

Disabilities Coordinator

Family Advocate

Family Worker

Floating Aide

Healthy Start Home Visitor

Healthy Start Program Manager

Office Support Assistant

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 English and Spanish
     BIRCHIS Individual Behavior Incident Report
     BIR Tracking Form
          
     Home Observation Card
     Home Visit Observation Card in Spanish
     Observation Card
     Behavior Tracking Form
     Data Collection Sheet
     Evaluating Support Plan
     Support Planning Chart
     Astoria Matrix Class Area
     Self Sufficiency 2011
     Self Reliance Tracker
     Income Change Form
     Blank Removal from Dependency Form

Blue Flyer 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

Cycle Menus

Program Training for New Staff

School Readiness Curriculum Guide

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
CFDP School Readiness Goals in English and Spanish
Lesson Plan Monitoring Checklist for Center Managers
Bus Observation for Center Manager
Center Manager Declaration of Understanding
CIGNA Insurance Booklet
Integrated Work 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
Cook
Court Parenting Specialist
Custodian
Director
Family Advocate
Family Worker
Floating Aide
Healthy Families Home Visitor
Healthy Families 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
 
 

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