“It’s All About Children and Families”

Serving Children and Families in Bledsoe, Grundy, Marion, Rhea, and Sequatchie Counties

Sequatchie Valley Head Start

Forms Manual

Phone: 1-800-762-8432

Phone: 423-837-6724

Fax: 423-837-9369

 

Sequatchie Valley

Head Start

170 Smith Lane

P.O. Box 769

South Pittsburg TN 37380

To Contact

Our Central Office

Administration

Assistant Teacher Performance Evaluation

Authorization for Electronic Funds Deposit

Bus Driver - Aide Job Description

Bus Driver Performance Checklist

Career Development - College Tuition Advance

Career Development Supplement Documentation

Caught You Being Good - 2-Up

Center File Checklist

Center Staff Meeting Format

Child's Record Marker

Cleaning and Sanitation Frequency Checklist

Computer-Printer Maintenance Needs

Confidentiality Procedure Training - Documentation

Consultant or Contractor Authorization Form

Consultant or Contractor Authorization Form - sample

Consumable Supplies Inventory - Less Than $10

Emergency Contacts and Normal Work Hours

Education & Classroom Questionnaire

Employee Performance Evaluation

Employment Application

Employment Candidate Rating Scale

FPA Evaluation Form

Independent Training Documentation

InKind Documentation

In-Kind Report

Inventory

Leave - Reschedule - Overtime Approval Request Form

Liability Release - Adult Volunteer

Liability Release - Minor Child Volunteer

Monitoring Checklist for Center Visits

Nutrition Worker Performance Evaluation

Nutrition Worker Physical Form

Occasional Contract Work - invoice form

Office Worker Physical form

Payroll Correction Form

Performance Appraisal - Education Assistant

Performance Appraisal - Education Clerk

Performance Appraisal - Family Partnership Assistant

Performance Appraisal - Office - Data Entry Clerk

Performance Appraisal - Probationary Employee

Performance Note

Performance Note for Documentation File

Personal Vehicle Mileage Log and

Reimbursement

Physical Tracking Sheet for Employees - 8 x 14 inch

Purchase Order Request and Authorization

Reasonable Suspicion Documentation

Receipt of In-Kind Donations - 4-Up

Request for Approval of Guest Children

Request for Assistance - NAEYC - ECERS

Request for Employment Application - 2-Up

Request for Food for Parent Meeting

Request for Reimbursement - 2-Up

Request for Training

Resignation

Rules for Volunteers

Signature Policy

Sign-In Sign-Out Sheet

Staffing Form

SVHS letterhead

Tax Exemption Certificate

Teacher - Volunteer Evaluation - 60-Day

Teacher Activity Scale

Teacher Performance Evaluation

Teaching Staff - FPA physical form

Team Leader Performance Evaluation

Telephone Log

Timesheet

Training Plan - Performance Related

Training Sign-In Sheet

Training Summary Sheet

Travel Request Approval/Advance Request

Travel Request Forms

Verification Form for Payroll

Administration -

Central Office Use Only

Application Employment Flow Sheet

Appointment and Employment Status Form & Verification of Payroll

Consultant - Contractor Authorization

Consultant - Contractor Authorization Form - Contract Labor Substitute - Bus Aide

Convictions Declaration

Education & Classroom Questionnaire

Employee Personnel File Checklist

Employment Application

Employment Interview Outline

Employment Status - Pay Plan

Exit Information

For Posting Job Opening - Sample

For Posting Job Openings

Non-Discrimination Tracking

Offerors' Certifications

Reason for Termination

Reference Questionnaire with Permission - Confidential

Reference Questionnaire without Permission - Confidential

Reimbursement Rates

SVHS letterhead

Disabilities

Disabilities Forms by Section

Individualization Plan and Instructions

Instructions for and Release of Confidential Information

Provision of Services and Instructions

Referral Form and Instructions

Summary of Contacts Regarding Delivery of Service and Instructions

SVHS letterhead

Teacher Checklist

Teacher Checklist for Referrals

Early Childhood Development Plan

Alphabet Knowledge Assessment

Alphabet Knowledge Assessment and Instructions

Alphabet Knowledge Record

Book-A-Night Notice - 2-Up

Center File Checklist

Center Maintenance or Improvement Request

Center Staff Meeting Format

Center Volunteer Roll Sheet and Example

Change of Status Action

Child and Adult Care Food Program - Guide for Review

Child Behavior - Observation Checklist

Child and Adult Care Food Program - Monitoring

Classroom Literacy Checklist

Cleaning and Sanitation Frequency Checklist - monthly

Confidential Transition Form & Instructions

Confidentiality Procedure Training - Documentation

Confidentiality Procedure Training Form

Consent for Screening

Consumable Supplies Inventory - Less Than $10

Daily Lesson Plan Form

DECA - Behavioral Concerns Observation Summary

DECA - Behavorial Concerns Observations Review and Analysis

DECA - Classroom Profile

DECA - Individualized Positive Guidance Plan

DECA - Observation Form

DECA - Reflective Checklist for the Environment

Educational Monitoring Check List - Site Visit

ED12

ELL Observation Checklist

Emergent Reading Check

End-of-Year Conference

Father Figure Registration Form

Field Trip Request - From Staff

Fire Safety Record and Enforcement Code

First Conference

First Enrollment Contact Tracking Form

First-of-Year Conference

Guidelines for Choosing Babysitters

Holiday Food Policy - Parent Notice

Home Activity Plan

Individual Lesson Plan Supplement

Individual Transition Plan & Instructions

Individualization Plan

Inventory

Keeping Kids Safe - Personal Safety Curriculum

Language-Art-Music Observations

LAP Personal-Social Scoring Sheet

LAP Self-Help Scoring Sheet

LAP-D Assessment Report to Parents

LAP-D Assessment Report to Parents - Beginning of Year

LAP-D Assessment Report to Parents - End of Year

LAP-D Assessment Report to Parents - Mid-Year

LAP-D Parent Letter

Liability Release - Minor Child Volunteer

Licensing Requirements - Tennessee Child Care Centers

Mid-Year Conference

Minutes Form for Documentation or Notes

Monthly Attendance

NRS Classroom Children Data Collection Form

Observation Assessment Instructions

Observation Checklist - Child Behavior

Parent - Child Reading Activity

Parent Activity Fund Check or PO Request

Parent or Guardian Curriculum Input or Interest Area

Parent Sign-In & Sign-Out - 2-Up

Performance Note

Permission - Agreement Form

Personal Safety Curriculum Notification Form Blank

Personal Safety Curriculum Notification Form Talking About Touching

Personal Safety Curriculum - Family letter No. 1

Personal Safety Curriculum - Family letter No. 5

Personal Safety Curriculum - Family letter No. 9

Personal Safety Curriculum - Instructions & Requirements

Personal Safety Curriculum Documentation Form

Personal Safety Curriculum Documentation Form

Phonological Awareness Assessment - p 1

Phonological Awareness Assessment - p 2

Phonological Awareness Assessment - pp 1 & 2

Phonological Awareness Assessment Instructions

Playground Maintenance Checklist

Playground Maintenance Checklist - Instructions

Policy Council Reimbursements - Members Alternates

Policy Council Sign-In Sheet

Portfolio Contents

Reading Home Activity

Request for Approval of Guest Children

Rules for Volunteers

Second Enrollment Contact Tracking Form

Second Step Planning Sheet - Documentation

Second Step Planning Sheet - Instructions

Site Visit Form

Social Services Tracking

Speech and Language Screening Summary

Speech and Language Screening Summary Instructions

Staffing Form

SVHS letterhead

Talking About Touching Curriculum - Documentation

Teacher Checklist by Child - Mental Health - 1 of 2

Teacher Checklist by Child - Mental Health - 2 of 2

Teacher Checklist by Child (Literacy)

Teacher Checklist by Child (Portfolio)

Teacher Checklist by Child Instructions

Teacher Observation Checklist & Instructions

Telephone Contact Log - Family and Other

Third Enrollment Contact Tracking Form

What Do I Say Now - How to Protect Your Child from Sexual Abuse

Family & Community Partnerships

Application - Page 1

Application - Page 2

Change of Status Action

Emergency Information Form

Family Partnership Agreement 2007-08

Family Partnership Agreement Introduction

Father Figure Registration Form

Follow Up Plan for Goals

Follow-Up Plan for Goals (Spanish)

FPA Evaluation Form

FPA Checklist

Goal Setting with Families

Income Worksheet

InKind03

Policy Council Reimbursement Form

Recruiting Tool

Social Services Tracking

 

more forms to come

Health

Accident Report Child

Accident Report Staff

Blood Exposure Report

Child Health History 3 pages

Child Health Screening Record

Cleaning and Sanitation Frequency Checklist - monthly

Communicable Disease Letter Chicken Pox

Communicable Disease Letter Conjunctivitis

Communicable Disease Letter Diarrhea

Communicable Disease Letter Fifth Disease

Communicable Disease Letter Hand Foot and Mouth Disease

Communicable Disease Letter Hepatitis A

Communicable Disease Letter HIB

Communicable Disease Letter Impetigo

Communicable Disease Letter Meningitis

Communicable Disease Letter Pinworms

Communicable Disease Letter Ringworm

Communicable Disease Letter Scabies

Communicable Disease Letter Scarlatina

Communicable Disease Letter Scarlet Fever

Communicable Disease Letter Strep Throat

Communicable Disease Notice

Confidential Release of Information Form

Consent for Dental Treatment Form

Denial of Consent for Dental Treatment Form

Dental Control Sheet

Dental Exam Letter Children Needing Treatment page 1 of 2

Dental Exam Letter Children Needing Treatment page 2 of 2

Dental Exam Letter Children Not Needing Treatment page 1 of 2

Dental Exam Letter Children Not Needing Treatment page 2 of 2 (Tips)

Dental Exams - Reminder of Exams to be done at Center

Dental Form Consent for Exam

Dental Release of Information Form

Dental Treatment Not Complete by School End

Dental Verification

Developmental Screening Results Form

Emergency Health Care Plan for Allergies

Head Lice Parent Letter 1 of 3

Head Lice Parent Letter 2 of 3

Head Lice Parent Letter 3 of 3

Health Care Plan

Health Care Plan for Asthma attacks

Health Care Plan for Seizures

Health History Update Returning Children

Health Referral Form

Health Screening Day Result

Health Screening Results for Parent

Hepatitis B Vaccination Acceptance

Hepatitis B Vaccination Declination Statement

Lead Risk Form

Medical or Dental Appt Consent Form

Medication Administration Record

Medication Permission Form

Nutrition History Form

Parent Permission Med Dent Screening

Site Safety Checklist

Special Diet Documentation Form

Speech Language Screening Day Results

Staffing Form

Toothbrush Log

Tracking Form for Health and Mental Health

Tracking Form Quick Check

Well Child Physical Exam Form

 

more forms to come

Health - Central Office Use Only

Blood Exposure Incident Report for physician providing evaluation

Blood Exposure Post Exposure Evaluation and Follow Up

Consent for HEP B and HIV Blood testing for EE

Consent for HEP B and HIV Blood testing form

 

more forms to come

Transportation

Bus Attendance Record

Bus Driver Daily Inspection Report

Bus Driver Performance Checklist

Bus Expense Worksheet

Bus Transpo Log

Delivery Attempt

Field Trip Transpo Log

Individual Transportation Plan

Mileage Sheets for HS Vans

Mileage Sheets for HS Vehicles

Monitor Skills

Pickup Attempt

Seating Chart Regular Bus - 1 blank

Seating Chart Regular Bus - 2 blanks

Transportation Log Instructions

Van Reservation List

 

more forms to come

Mental Health

Child Mental Health Parent Involvement Form

Confidential Release

Mental Health Classroom Observation

Mental Health Consultation Form

Mental Health Observation Form

Pre-Referral Checklist

Tracking Form - Health and Mental Health

 

more forms to come

Policy council

PC Minutes Form

PC Reimbursement Form

PC Sign-In Form

Policy Council Reimbursements - Members Alternates

Policy Council Sign-In Sheet

 

more forms to come

Policy Council -

Central Office Use Only

PC Approval Form

 

more forms to come

Reader

Required

Nutrition Services

Daily Meal Counts

Daily Temperature Log

Food Services Inventory

Monitoring Form for Child and Adult Care Food Program

Meal Counts and Menu Items Worksheet

Non-Food Services Inventory

Weekly Meal Count Form

Weekly Milk Inventory

 

more forms to come