PSESD Mission Statement

Head Start — Forms

Documentation and record keeping are essential to your work with children and families. Our program has many forms whose purpose is to ensure that all necessary information is saved in a way that is complete, accurate, and time-saving. These forms include all areas of our program and are listed in alphabetical order. Select the form you need from the list below and access it by clicking on it.

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Important Notice:

NEW  The 2014-15 Recruitment and Enrollment forms can be found here.

The 2013-2014 Recruitment and Enrollment forms can be found here.


Access Log Family File

Accident and or Illness Log

Accident and or Illness Report

Administrative Monitoring Checklist

Attendance Meal Count

Bilingual Instructional Assistant Request

CDC Growth Chart: Boys 0-36 Months

CDC Growth Chart: Girls 0-36 Months

Center Director Recommendation for New Permanent Hire

Certificate of Immunization Status - Spanish

Child Abuse/Neglect Training Documentation

Child Abuse Report

Child Abuse Reporting - Self Monitoring

Child Development Accountability Checklist Head Start 2012-13

Child Development Accountability Checklist - EHS Center Based

Child Development Accountability Checklist - Home Based

Child Development Enrollment Info

Child Development Visit Summary - Center Based

Child Health Plan

Child Health Plan for Food Intolerance/Allergy

Child Health Plan for Non-Food Allergies

Child Health Plan for Reflux for Infants and Toddlers

Child Health Plan for Skin Condition

Child Supplemental Food Plan

Classroom Planning - EHS

Community Contact Log

Community Agency Visit Report

Consent for Use of Interpreter     translated:  Spanish

Contact Tracking

Continuity of Care Claim Authorization to Pay

Continuity of Care Funds Request (PDF) /  Other version:  Fillable (Word)

Curriculum Planning for Socialization Experiences

Daily Activity Chart for Infants and Toddlers

Daily Infant Meal Record

Declaration Form for Prospective Employees

Dental Exam Report

Disabilities Services Checklist

Emergency Drill Report

Emergency Plan

Enrollment Checklist

Exposure Notices

Family Child Care Provider File

Family Goals and Resources Worksheet Translated: Spansih

Family Participation - Ways to be Involved

Family Partnership Agreement - EHS Translated: Spanish

Family Partnership Tracking Record-Contact Log (PDF) /  Other version:  Fillable (PDF)

Family Partnership Record Tracking Labels

Family Partnership Summary

Family Support File Review

Family Support Monthly Summary Report

Family Support - School Readiness Transition Info (0-5 Years)

Family Visit Summary

File Contents - Child Development - EHS

File Contents - Education

File Contents - Family Partnership - EHS

File Contents - Family Partnership

File Contents - Health and Nutrition (0-5 years)

File Contents - Prenatal and Postpartum - EHS

Fire Safety and Evacuation

Food Alert

Food Introduction Record

Food Temperature Record

Getting to Know Your Child Here at Head Start! /  Translation:  Spanish

Head Start, A Family Program /  Translations:  RussianSpanishVietnamese

Health & Safety Checklist - FD/FCC

Health & Safety Checklist - PD

Health and Developmental History 0-12 months

Health and Developmental History 1-5 years

Health Care Provider Statement Dietary Accomodations-Food Allergies

Health Care Request for Funds

Health Nutrition Accountabilty Checklist

Health Nutrition-School Readiness Transition Information (0-5 years)

Health Referral

Health Screening Results

HOVRS - Home Visit Rating Scale

Important Notice /  Translations:  RussianSomali SpanishVietnamese

In Kind Professional Serices - Donations

In Kind Volunteer Services Sign-in Sheet

Incident Report

Individual School Readiness Goals

Individual School Readiness Goals Summary

Interpreter Feedback

Interpreter Phone Log

Interpreter Timesheet

Lead-Hematocrit/Hemoglobin Fax Cover Sheet

Lead Letter to Providers

Maternal Depression Screening /  Translation:  Spanish

Meal Monitoring Checklist - Child Development

Medical/Dental Exam Letter to Parent /  Translations:  RussianSomaliSpanishVietnamese

Medication Administration - Parent/Guardian Authorization

Medication Administration - MD Statement

Medical Release

Medication Record

Mental Health Request for Observations/Consultation

Menu Cover Sheet

New Hire Checklist

Nutrition Request for Consultation

OAE Parent/Guardian Information Letter   Translation: Spanish

One time Funds Request

Outcomes Questionnaire Resource List

Parent-Child Play and Learn /  Translation:  Spanish

Parent Consent for Animals in the Environment

Parent Fund Expenditure Report

Parent/Guardian Notification of Medication Policy and Procedures

Parent/Guardian Request for Milk Substitution

Parent Notification for Service Animals in the Environment

Parent Staff Agreement /  Translations:  RussianSomali Spanish Vietnamese

Parent/Staff Hiring Recommendation Form

Parent Training Topics Tracking

Policy Council Letter of Introduction

Policy Council Parent Fund Budget Report

Postpartum Visit Summary

Pregnancy Visit Summary

Pregnancy Health History

Pregnancy / Postpartum Education & Services Checklist

Professional Development Claim for Reimbursement

Professional Development Fund Preapproval - ESD Staff only

Professional Development Fund Preapproval - Non-ESD Staff only

Promoting Parent Child Relationships Taling Points 

PSESD Early Learning Organization Chart

Publicize Early Learning Center Staff Opening

Quality Assurance Plan

Recruitment and Enrollment 2013 - 2014

Release/Exchange of Confidental Mental Health Information

Release/Exchange of Confidential Health Information

Release/Exchange of Confidential Information (Non Health)

Release/Exchange of Confidential Information - School Districts

Research Questionnaire

SeaMar Oral Screening Consent /  Translation:  Spanish

SeaMar Oral Screening Results /  Translation:  Spanish

Selection Worksheet

Spring Growth Results

Staffing Dates Tracking

Staffing Guide - Early Head Start

Staffing Guide - Preschool Head Start

Staff Information Form

Staff To Do List

Sunscreen Application Record-Individual Container

Sunscreen Application Record-Bulk

Sunscreen Authorization Form-Individual Container

Sunscreen Authorization Form-Bulk

Survival Tips for New Volunteers /  Translation:  Spanish

Suspected Foodborne Illness Report

Training Certificate

Transfer Records Checklist - Leaving ESD

Transfer Records Checklist - within PSESD

Transportation Information - Part Day

Transportation Services Checklist - Monitoring

Triage Support Form

Universal Precautions Training Center Director - Self-Monitoring

Universal Precautions Training Self-Monitoring Requirements

USDA Enrollment Forms

Vision and Hearing Checklist (0-3) part 2

Vision and Hearing Parent Interview Question (0-3) part 1

Vision and Hearing Screening Summary (0-3) part 3

Vision Screening Referral Letter 3-5 Years

Volunteer Orientation to Head Start Policies /  Translations:  RussianSomaliSpanishVietnamese

Volunteer Training Log

Vounteers Working with Children

Well Child Exam - 2-4 weeks

Well Child Exam - 2 months

Well Child Exam - 4 months

Well Child Exam - 6 months

Well Child Exam - 9 months

Well Child Exam - 12 months

Well Child Exam - 15-18 months

Well Child Exam - 2 years

Well Child Exam - 3 years

Well Child Exam - 4 years

Well Child Exam - 5 years

When I Give Consent /  Translations:  ArabicRussianSomaliSpanishVietnamese

 

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