Westmoreland Community Action
226 South Maple Avenue Greensburg, PA 15601

Head Start Forms

These forms are used on a regular basis internally to conduct the day to day business of the agency.

2011 - 2012 Teacher's Index

CHD01 Child Health Record 2013

CHD03 Physical and Dental Tracking Form

CHD04 CSS Tracking Form

CHD04 CSS Tracking Form Directions

CHD05 Physical

CHD06 Child Immunization-Exemption Form and Dir

CHD08 Dental Form

CHD09 Dental Treatment Completion

CHD10 Survey Barriers to Completion Letter

CHD15 Screening and Referral Health Summary Form

CHD18 Parent Permission

CHD21 Screening Appt. Letter

CHD26 Child Health Care Plan

CHD31 Physicians Order Medications

CHD32 Medication Log Form

CHD39 Growth Assessment Referral

CHS Diaper Changing Procedure

CHS Diapering Procedure for Changing a Soiled Pull-up

CHS01 Field Trip Publicity Permission Form

CHS03 Emergency Notification Form

CHS04 Sign In/Out Sheet

CHS05 Accident Report Child and Volunteer

CHS16 Health Supplies Form

CHS21 Sanitation Schedule Cleaning Guidelines

CHS25 Injury Tracking Log Form

CHS26 Illness Tracking Log Form

CHS31 Diapering Form

CHS36 Infectious Disease Letter

CN Store Charge Requisition Excel Spreadsheet

CN01 Nutrition Related Health Problems

CN05 Nutrition Profile

CN25 List of Nutri Act and Food Pre Act for Children 2008

CN30 Procurement Procedure of Child Care Centers

CN45 2010 Production Sheet Form

CN50 Food Safety and Sanitation Checklist

CN55 Monthly Food Inventory Form

CN60 Self Assesment Nutrition Services

CN65 Cultural Foods in Head Start

CN70 School Menu Production Record

CN75 Tracking Nutritional Education Handouts

DB01 Documentation of Services Form

DB04 Permission for Evaluation

DB05 Directions for the Social Emotional Observation Tool

DB05 Social Emotional Observation Tool

DB06 Practices to Promote Social Competence

DB08 Contingency Plan for Extreme Child Behaviors in the Head Start Classroom

DB08 Directions for Contigency Plan for Extreme Child Behaviors in the Head Start Classroom

DB11 Parent Permission Form for Behavior Intervention

DB89 Extreme Behaviors Form Incident Report

ECD01 Lesson Plan

ECD02 Daily Journal

ECD03 Parent and Child Activity Booklet 2010

ECD06 Parent and Child Activity Letter

ECD07 Parent-Child Activity Form

ECD10 Parent Teacher Conference Signature Page

ECD12 Creative Curriculum Learning Games 36-48 mos Checklist

ECD13 Creative Learning Games 48-60 mos Checklist

ER Univ AD

ER02 Absence Excuse

ER06 Head Start Application Extra Income Form

ER10 Head Start Application Special Circumstances

ER13 Recruitment Memo To Parents

ER15 Recruitment Parent Letter Referrals

ER20 Recruitment Plan

ER25 Head Start Application Request

ER30 Recruitment Letter to Families Without Phone

ER35 Head Start Application Checklist

ER45 Enrollment No Contract Letter

ER50 Head Start Application You Have Completed App Letter

ER55 Enrollment Withdraw

ER60 Recruitment Poster Placement List

ER65 Recruitment Daily Log

ER70 Recruitment Family & Community Activity Form

ER75 Head Start Application What to Bring Checklist

ER80 Enrollment Memo

FAC05 Evacuation Log

FAC10 Evacuation Plan Procedure

FAC15 Playground Checklist

FAC20 Classroom Daily Checklist

FAC25 Safety Checklist for Active Play Areas

FP05 Child Data Tracking Form

FP06 Family File Contents 2010

FP07 Center Files Contents 2010

FP13 Family Partnership Plan 0910

FP18 Monthly Family Update Contact Summary 2012

FP18 Monthly Family Update Directions 2012

FP19 Referral Form New

FP19 Referral Form Directions

FP23 Family Visits Cancelled

FP28 Family Visit Partnership Plan

FP30 Family Circles Assessment Directions

FP30 Family Support Assessment

FP32 Program Goals

FP32 Program Goals Directions

FP34 Fam Goals Form

FP36 Family Contact Summary

FP40 2010 Parent Interest Survey Directions

FP40 Parent Volunteer Interest Assessment 2012

FP45 Home Visit Observation Form

FP50 Transition Release

FP55 Family Review Observation Directions

FP55 Family Review Observation Form

FP56 Family Review Notes

G03 Calendar

HR04 PDR Training Form a

HR04 b Professional Devel. Plan

HR06 Education Agreement Crea

HR07 Educational Funds Survey

HR08 Training Planning Form

HR09 Individualized Training Form (new)

HR11 Accident Report - May 2008

HR13 Personal Update

HR14 Staff Health Appraisal 2013

HR18 Code of Conduct

HR19 Confidentiality Statement

HR30 Staff Logs

MS01 Special Events

MS02 Special Events Planning Log

MS03 Advance Recon

MS05 Record Presentations

MS06 Record Items

MS10 Volunteer Sign In Sheet

MS15 PTCASH Reconsiliation


MS25 Center Supply Order List

MS30 Transfer of Property

MS40 Monthly Checklist

MS45 Staff Minutes

PG01 Parent Get Together Invitation

PG01 and PG02 Parent Get-Together Guidelines

PG02 Parent Get-Together Metting Minutes

TRA01 Bus Safety Policy

TRA02 Trans Acknowledgement Directions

TRA10 Transportation Checklist

TRA15 Transportation Bus Drill

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